Less life threatening differential diagnoses

Mark H Ebell ebell at UGA.EDU
Sun Aug 2 03:58:49 UTC 2015


As a primary care physician, we often see diseases early in their course, when signs and symptoms overlap with other conditions and biomarkers may be negative (think lupus). Unfortunately, there is no funding in the US to study clinical diagnosis in the primary care setting, at least not as long as NIH is dominated by basic scientists and sub specialists. That would be the only way to identify the truly useful signs and symptoms (or more likely combinations).

Mark

—
Mark H. Ebell MD, MS
Professor of Epidemiology University of Georgia
Editor, Essential Evidence Deputy Editor, American Family Physician
ebell at uga.edu


From: Carmel Crock
Reply-To: Society to Improve Diagnosis in Medicine, Carmel Crock
Date: Saturday, August 1, 2015 at 9:55 PM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>"
Subject: Re: [IMPROVEDX] Less life threatening differential diagnoses

Dear Rob
I thought I would mention that at our Eye and ENT hospital emergency department, shingles is one of our commonest missed or delayed diagnosis, as patients present early with severe eye or ear pain but nothing (or little) to show on clinical examination.
Regards
Carmel Crock
________________________________
From: robert bell [0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
Sent: Sunday, 2 August 2015 9:08 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Less life threatening differential diagnoses

To me it seems that despite frequency patterns medical students are rightly taught at great length to focus on not missing the life threatening diagnosis. Is this done at the expense of missing the diagnosis with less dangerous competing conditions that are on the differential diagnostic list.

For example, how much do most medical students/residents know about shingles pain and symptoms prior to lesion development, with any lack of knowledge leading to the “diagnosis” of possible acute abdomen?

I would argue that in training knowing FAR more about the less dangerous differential diagnoses would get us more quickly to an accurate diagnosis, at possibly lesser cost.

So should there be in training more focus on the less serious competing differential diagnoses?

Rob Bell









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