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:

Congenital
Vascular
Degenerative
Trauma
Infection
Tumor
Inflammatory
"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:

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.