Episode 1 - My Framework For Diagnosis

Jean's Podcast

Lets start with the case history.

• Full case history - First job is to greet the patient, welcome them, explain the process and gain informed consent (this is a big topic that most therapists don’t understand in the slightest - I will do a separate video on this). Ask if they have any questions before starting (you can address nervousness, anger etc here before you start - very important) then start to rule out red flags and make sure your patient is appropriate for your scope of practice.

The first section in the case history is about their presenting complaint (i.e. what they came to see you for). There are many ways to do this section. You can ask a set number of questions that you should ask, or you can let the patient talk about what is wrong and you can note down the key parts of what they are saying. Both work, it just depends on your style and what type of patient you have in front of you (talkative, angry, sad etc). The questions you should ask relate to you trying to understand what is going on. These are:

1/ what, when and how did it happen

2/ how has it affected your day to day, is your function affected

3/ is it getting better or worse

4/ any neurological signs or symptoms

5/ any associated signs or symptoms

6/ quality and nature of the pain

7/ have you had this before

8/ better for, worse for factors

9/ Previous history of pain and interventions

10/ what are you expectations in coming to see us

11/ What are your concerns and beliefs about what has happened

12/ how bad is the pain on a 1-10 scale

13/ daily pattern

14/ occupation + hx

Next you have your medical health history. One needs to enquire about the following:

Smoking/drinking

Accidents

Illnesses

Surgeries

Investigations - BT CT MRI etc all of them

Medication

Family history

Nutrition/diet

Lifestyle

Exercise

Next is your systemic enquiry. These are specific questions related to various systems in the body (such as asking about dizziness and low blood pressure). General questions should be asked to all patients irrespective of their presenting complaint. More detailed and specific questions must be asked when you are clarifying the diagnosis or there are many things going on. For example, calf pain on walking up a hill can be a completely different diagnosis to calf pain when walking down a hill. You would use focused systemic questioning to figure out if there calf pain was vascular in nature or mechanical. Without looking for these risk factors, you cannot know which differential diagnosis to follow.

The categories are:

CVS

Resp

Endocrine

Gastro

Urogenital/gynae

Bowel/bladder

Psychosocial

Other that is relevant (headaches, constitutional symptoms, sleep, stress, vision, ears, energy, pregnancy/children, bruising, general well-being etc)

The last part (and one that is very important) is to ask the patient if they have any questions or anything else to say/add before moving on (you would be surprised as to how many times patients have said something very important at this stage that had the potential to change the entire course of action).

Next section is examination:

• Examination - first job is to explain what and why you are examining, the risks involved, alternatives available and subsequently gain informed consent. Your examination is used to confirm or reject your working diagnosis. This means that your testing has to be directly relevant to what you think may be going on with your patient. Not just testing random stuff. It is well known that if you have no idea wha

Rozdziały

1. Episode 1 - My Framework For Diagnosis (00:00:00)

2. The only caveat allowing a clinical to divert from the process (00:01:54)

3. What is a red flag? (00:01:58)

4. Examples of red flags (00:02:27)

5. Section 1 - What is a diagnosis and why diagnose? (00:02:36)

6. When it goes wrong (00:03:56)

7. The 5 components of the framework (00:06:09)

8. Full case history (00:06:24)

9. Examination/testing (00:11:47)

10. Diagnosis (00:15:21)

11. Treatment (00:16:10)

12. Management plan (00:16:51)