Things that bug me 4 – inadequate specification of symptoms or diagnoses
The patient had diarrhea last night.
The patient complains of chest pain.
The patient has diabetes (or CKD or heart failure).
What do these 3 sentences have in common? Â When I hear them or read them, I want to know more!
Perhaps explaining what I want to know will make the point clear.
Please describe the diarrhea – how many? Â watery or loose? Â incontinence? exactly when did it start? Â does it persists?
Where is the chest pain? Â What is the characteristic of the pain? Â Does it radiate? Â How long does it last? …
How long as the patient had diabetes, and which flavor of diabetes does h/she have? Â What medications does the patient take for the diabetes? What is the last HgbA1c? What stage CKD does the patient have and what caused the CKD? Â Define the heart failure (systolic dysfunction, preserved ejection fraction, etc.) and specify how severe it is?
Am I expecting too much? Â Obviously I do not think so. Â A good history, and therefore a good presentation gives me the information that I need to consider a differential diagnosis. Â Without adequate specification, I am lost, and will make more diagnostic errors, and order unnecessary tests.
We should all work with our learners to make certain that their presentations have adequate specification. Â I make this point repeatedly when I start my teaching rotations. Â Yet I often have to re-emphasize these points.
Source: DB's Medical Rants - Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
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