![]() BUN/Cr 20/1.5 on BMP with baseline Cr 0.7 from a couple of years ago Labs are significant for hgb 5.4/20, plt 946, WBC 15. Physical exam is significant for tachycardia to 100s but stable BP, she appears fatigued, has hand joint deformities consistent with RA, breath sounds are decreased bi-basilarly. SH: Lives in queens with her daughter, was lost to follow up one to two years ago because she had to go back to Ecuador to take care of a daughter with cancer, just returned and is now trying to re- establish care with prior doctors ![]() PSH: C section, appendectomy Meds: diclofenacįH: daughter with asthma, another daughter with unknown type of cancer PMH: bronchiectasis with MAI, RA only on NSAIDS ROS: progressive fatigue over the last few months, maybe lost some weight too.Cough/ copious sputum production x at least 1-2 months, prescribed a course of azithro maybe 2 months ago, last week prescribed a course of levaquin x 7 days, maybe slightly better? The cough is still bothering her.Coffee ground colored stool about three times last week.How about we first just read their H&P, okay. John: … c an’t help but notice Cindy that ever since you took over writing Hoofbeats episodes that your on-air voice has gotten noticeably crabbier. But long story short, she’s here for melena and has a bit of AKI, ED has already called GI for us, oh she’s also got pneumonia too, ED also called pulmonary for us.Ĭindy: What, ED didn’t call renal for us? She is pretty hard of hearing and is Spanish speaking so I couldn’t really do a full interview with the interpreter phone yet, PLUS the daughter insisted on telling me what’s going on herself, so most of the information is from the ED and her daughter at bedside. Hey, this patient just rolled up half an hour ago, I’m still working on the admission but let me tell you about her really quick. An overnight resident is going to tell you about an admission. John: A nd I’m John Hwang, also NYU faculty working at Bellevue Hospital in New York City.Ĭindy: Imagine you are the day team resident or the attending physician listening to a case on teaching rounds. Use promo code COREIM for 1 month of free access to Glass Pro!Ĭindy: Hi everyone, Welcome back to another episode of Hoofbeats, where we challenge you to solve diagnostically difficult, real world cases alongside experienced clinicians. Sponsor: Glass Health builds a medical knowledge management platform that helps physicians learn medicine faster and leverage their knowledge to provide better patient care. Problem representation should be dynamic and flexible.You can’t get to the right answer by trying to solve the wrong problem! When we have difficulty solving the problem at hand, it is helpful to retrace the steps instead of being committed to solving the perceived problem.Data collection, interpretation, and abstraction need to take place before the generation of problem representation, and errors in each step can lead to a faulty PR.A problem representation is a mental model we construct that summarizes our understanding of the problem, it is not the same as summarizing all of a patient’s abnormal findings.On the other hand, physicians may discard a valid hypothesis prematurely due to the existence of outliers or when data appear to be unrelated at first glance.Crabtree’s Bludgeon questions whether any diagnosis can be safely considered “true”, since ad hoc explication is so tempting for physicians.It can be very tempting to forget Crabtree’s Bludgeon and coerce unrelated data into a coherent theory.However, do NOT expect patients to follow them like clinical rules.Hickam’s dictum suggests more often there are many true diagnoses.Occam’s razor suggests that there is such a thing as the one true diagnosis.Occam’s razor tends to hold true in young, immunocompetent patients, whereas patients with immunocompromised state, advanced age or with lack of access to health care can have multiple unrelated diagnoses. These rules are typically applied based on the clinical context. ![]() Occam’s razor and Hickam’s dictum can be useful diagnostic tools, but they should be applied to the reaso ning process with flexibility and caution. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |