How to Take a History—Pathology
OK, now, we have:
- Identified our chief complaint
- Generated a list of syndromes which could contain the chief complaint
- Asked questions to rule in/rule out these syndromes
- Identified anatomic locations for our suspected clinical syndromes
- Asked questions to rule in/rule out these locations
Finally, we shall think about WHAT CAUSED the problem. Onward, resolute physician, to identify pathological entities occurring at these anatomical locations to explain these clinical syndromes.
Basically, I use a shopping list approach here. Yes, certain pathological entities leap out at you for certain problems. If it looks and quacks like a duck, it is most probably a duck. But not always.
If you discipline yourself to go thru your algorithm each time, you will tickle your subconscious mind to remain open to other possibilities as your treatment course progresses.
That way, if it becomes obvious that you guessed wrong, you can back up and take another look at what you thought was the problem. If, on the other hand, you leap and miss, you are in the unenviable position
of the coyote in the roadrunner cartoon who finds himself suspended in mid-air above the canyon.
My shopping list for pathological entitites generally causing disease is:
- "Medical": i.e. anything which doesn't fit into the above categories
Run your list on every patient, and especially at every conference, and you will actually begin to see connections appearing that were inapparent at first.
As an example, consider this CT scan:
Pencil and paper ready? OK, start generating diseases which can look like this.
My (incomplete) LIST
Now on to some GENERAL COMMENTS about this whole business.