Blog | Friday, April 21, 2017

Things that bug me about inadequate specification of symptoms or diagnoses


1. The patient had diarrhea last night.
2. The patient complains of chest pain.
3. The patient has diabetes (or CKD or heart failure).

What do these 3 sentences have in common? When I hear them or read them, I want to know more!

Perhaps explaining what I want to know will make the point clear.
1. Please describe the diarrhea: How many? Watery or loose? Incontinence? Exactly when did it start? Does it persist?
2. Where is the chest pain? What is the characteristic of the pain? Does it radiate? How long does it last?
3. How long as the patient had diabetes, and which flavor of diabetes does he/she have? 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? Define the heart failure (systolic dysfunction, preserved ejection fraction, etc.) and specify how severe it is?

Am I expecting too much? Obviously I do not think so. A good history, and therefore a good presentation gives me the information that I need to consider a differential diagnosis. 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. I make this point repeatedly when I start my teaching rotations. Yet I often have to re-emphasize these points.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.