Sunday, April 15, 2012

Family Medicine Activist: SPIT Out Better Diagnoses

As patients tell their story that relates to their main concern during a problem oriented office visit in Family Medicine, the Family Physician develops a list of probable causes for the problem(s).  This is called a differential diagnosis, an essential element of "physicianing".  There are many ways that physicians analyze patient information to hone in on the differential diagnosis, while simultaneously seeking to identify THE most accurate diagnosis and its cause(s).

To expand my development of the differential diagnosis, I use several models, the simplest of which is the SPIT model.  I ask myself, "What is Serious that can cause this situation (of patient symptoms and signs as relayed through their story and our physical examination)?  What is Probable (most likely given the context and our understanding of the risks in their unique circumstances)?  What is Interesting (an unusual or novel cause or the patient's/their family's theory of causation)?  What is Treatable that could be the cause(s)?

S erious
P robable
I nteresting
T reatable

For each symptom a patient had, we should be able to identify a SPIT differential diagnosis.  When I teach this to medical or nurse practitioner students, I encourage them to "SPIT" out their differential diagnosis, which gradually helps them with the speed of thinking about and refining their differential diagnosis.  I share this model with patients frequently to engage them in the process and reassure them that a lot of thinking is occurring during our interaction.

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