Sunday, October 2, 2011

Family Medicine: The Differential Diagnosis

How do Family Physicians analyze patient complaints?  Traditionally, the Chief Complaint (CC) is the driving force in the patient's and doctors minds.  The physician will listen to and expand the patient's story to develop a differential diagnosis, a list of possible causes of the CC.

I like to start with a four component acronym to cover four types of possible causes for the CC:  SPIT, which stands for Serious, Probable, Interesting and Treatable.

What is Serious (potentially causing loss of life, limb or a significant life function) that could cause the CC?
What is Probable (given the patient's life situation, age, gender, work, exposures, etc.) that could cause the CC?
What is Interesting (unique or novel from the physician perspective or the patients theory of causation- very important if they have a theory about the cause) that might cause the CC?
What is Treatable (responsive to a known therapy) that might cause the CC?

How does this fit into the Human Centered Health Home (HCHH) that I've promoted in this blog?  Here's an expanded explanation from a post in November of 2010:   Using SPIT in the HCHH

From the simple SPIT Acronym, the thinking may get more focused before expanding again as the physical exam is performed to further clarify possible causes of the patient's CC and lead to revision of the SPIT list.  Many other mental models and decision aids are used by Family Physicians from time to time as they engage a wide variety of patients.

How do you like to think about causes of symptoms, illness and disease?


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