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Diagnostic process
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Diagnostic Process

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Diagnostic Process

  1. 1. WHY? <ul><li>Know the specific pathophysiology </li></ul><ul><li>Know the natural history (prognosticate) </li></ul><ul><li>Inform patient of the diagnosis </li></ul><ul><li>Appropriate investigation </li></ul><ul><li>Treatment </li></ul><ul><li>Communication within medical profession </li></ul>DIAGNOSTIC PROCESS IN PRIMARY CARE
  2. 2. <ul><li>‘ Disease-centered diagnosis’ </li></ul><ul><li>‘ Patient-centered diagnosis’ – </li></ul><ul><li>includes the patient’s thoughts and feelings concerning their complaints </li></ul>
  3. 3. WHAT IF WE CANNOT MAKE A DIAGNOSIS? <ul><li>sometimes impossible to make a diagnosis </li></ul><ul><li>‘ diagnosis’ then can be expressed in the form of the patient’s problems </li></ul><ul><li>Nature of Primary Care </li></ul><ul><li>Front line of medicine </li></ul><ul><li>Undifferentiated symptoms </li></ul><ul><li>Varying degrees of severity </li></ul><ul><li>Using time as a waiting tool </li></ul>
  4. 4. INDUCTIVE METHOD OF PROBLEM-SOLVING <ul><li>Need to take a comprehensive history </li></ul><ul><li>System review </li></ul><ul><li>Complete physical examination </li></ul><ul><li>Investigations </li></ul><ul><li>Diagnosis </li></ul><ul><li>may not be used by all practitioners </li></ul><ul><li>time- consuming </li></ul><ul><li>unfocused </li></ul>
  5. 5. MURTAGH’S DIAGNOSTIC STRATEGY <ul><li>What is the probability diagnosis? </li></ul><ul><li>What serious disorders must not be missed? </li></ul><ul><li>What conditions are often missed (the pitfalls)? </li></ul><ul><li>Could this patient have one of the ‘masquerades’ in medical practice? </li></ul><ul><li>Is this patient trying to tell me something else? </li></ul>
  6. 6. Apply Murtagh’s strategy <ul><ul><li>Probability </li></ul></ul><ul><ul><li>Serious disorders </li></ul></ul><ul><ul><li>Pitfalls </li></ul></ul><ul><ul><li>Masquerades </li></ul></ul><ul><ul><li>Hidden agenda </li></ul></ul>Linda <ul><li>15-year-old girl </li></ul><ul><li>Headaches for the past 2 weeks </li></ul>
  7. 7. Serious ‘not to be missed’ conditions <ul><li>Neoplasia, especially malignancy </li></ul><ul><li>HIV infection/AIDS </li></ul><ul><li>Asthma </li></ul><ul><li>Severe infections, especially: </li></ul><ul><li>Meningoencephalitis </li></ul><ul><li>Septicaemia </li></ul><ul><li>Epiglottis </li></ul><ul><li>Infective endocarditis </li></ul><ul><li>Coronary disease </li></ul><ul><li>Myocardial infarction </li></ul><ul><li>Unstable angina </li></ul><ul><li>Arrthymias </li></ul><ul><li>Imminent or potential suicide </li></ul><ul><li>Intracerebral lesions, eg SAH </li></ul><ul><li>Ectopic pregnancy </li></ul>
  8. 8. Classic pitfalls <ul><li>Abscess (hidden) </li></ul><ul><li>Allergies </li></ul><ul><li>Candida infection </li></ul><ul><li>Chronic fatigue syndrome </li></ul><ul><li>Domestic abuse including child abuse </li></ul><ul><li>Drugs </li></ul><ul><li>Herpes zoster </li></ul><ul><li>Faecal impaction </li></ul><ul><li>Foreign bodies </li></ul><ul><li>Malnutrition (unsuspected) </li></ul><ul><li>Menopause syndrome </li></ul><ul><li>Migraine (atypical variants) </li></ul><ul><li>Pregnancy (early) </li></ul><ul><li>Seizure disorders </li></ul><ul><li>Urinary infection </li></ul>
  9. 9. Seven primary masquerades <ul><li>Depression </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Drugs </li></ul><ul><ul><li>Iatrogenic </li></ul></ul><ul><ul><li>Self-abuse </li></ul></ul><ul><ul><li>Alcohol </li></ul></ul><ul><ul><li>Narcotics </li></ul></ul><ul><ul><li>Nicotine </li></ul></ul><ul><ul><li>Others </li></ul></ul><ul><li>Anemia </li></ul><ul><li>Thyroid and other endocrine disorders </li></ul><ul><ul><li>Hyperthyroidism </li></ul></ul><ul><ul><li>Hypothyroidism </li></ul></ul><ul><li>Spinal dysfunction </li></ul><ul><li>Urinary infection </li></ul>
  10. 10. Is the patient trying to tell me something? <ul><li>Family conflict </li></ul><ul><li>Sick or deceased friends/relatives </li></ul><ul><li>Fear of malignancy </li></ul><ul><li>STDS/HIV </li></ul><ul><li>Impending “heart attack” </li></ul><ul><li>Sexual problem </li></ul>
  11. 11. The exceptional potential in each primary care consultation [Stott & Davis] A ACUTE presenting problems B BEHAVIORAL modification of health seeking behaviours C CHRONIC continuing problems D DISEASE PREVENTION opportunistic health promotion
  12. 12. <ul><li>Puan Esah is a 53-year-old housewife who has come to see the doctor with runny nose and low grade fever for 2 days. She has been taking honey to soothe her throat. She is a known diabetic patient. </li></ul><ul><ul><li>A – acute – runny nose and fever </li></ul></ul><ul><ul><li>B – behavioural – honey </li></ul></ul><ul><ul><li>C – chronic – diabetes </li></ul></ul><ul><ul><li>D – disease prevention – hypertension, menopause </li></ul></ul>
  • ZaraLaRoche

    Sep. 26, 2016
  • tineshh

    Mar. 31, 2016
  • SumuduWarnakulasuriya

    Jul. 29, 2015

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