Published: 21.02.2018 08:27

The patient history evidence based approach 2nd edition

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: The Patient History: An Evidence-Based Approach to

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Mark Henderson, ., .

Sriratanaviriyakul N, Nguyen LP, Henderson MC , Albertson TE. Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome (DRESS) Associated with Azithromycin Presenting Like Septic Shock: A Case Report J Med Case Rept 7569, 8:887.

The Patient History: Evidence-Based Approach (Tierney, The Patient

Extracting and teaching “key pointers” from expert-based resources have shown promising results in one medical curriculum 68 however, “key pointers” from critically appraised research evidences rather than pure personal experiences would be more reliable. 8 , 9 The number of different clinical presentations have been estimated to be around 675. 67 Given this, a comprehensive list of “key pointers” for this set of clinical presentations could be derived systematically. With this approach, EBM can significantly aid physicians at busy clinics in their struggle against “time constraint”.

Making a differential diagnosis list is a complex process based on clinicians’ knowledge, experience, and familiarity with the clinical presentation. However, several factors such as fatality, prognosis, prevalence, and treatability of diseases are important in prioritizing this list. 6 While a typical physician would become fluent with these factors after several years of experience, EBM can underscore them clearly and helps less experienced physicians with a particular presenting problem to quantify the utility of various diseases and making an unbiased list. 68

We have tried to summarize a general mental stream followed by experienced clinicians when encountering clinical problems. Merging the principles of evidence-based diagnosis to this course, one can be more confident in making most probable diagnosis in the least possible time.

Unlike ruling in depression in this patient which needs comprehensive evaluation, you can rule out depression by negative answers to just two questions (“key pointers”) with negative LR of about . 75 To rule in hypothyroidism, as described earlier, you will ask some questions from independent systems. To rule out hypothyroidism, however, you cannot rely only on clinical signs and symptoms (in contrast to positive LRs, negative ones are all insignificant). 69 In this case (no “key pointer”), an appropriate laboratory test (serum TSH) can clearly help you to decide about the presence or absence of the disease.

Most patients with a simple fainting spell, or vasovagal syncope, do not seek medical attention. Etiologies of syncope vary depending on the clinical setting, study population, definition of syncope, and rigor of the diagnostic evaluation. For instance, psychiatric disease generally causes pseudosyncope, not true syncope nevertheless, it is classified as syncope in a number of studies. In general, syncope is classified into the following major categories:

Jerant A, Fancher T, Fenton JJ, Fiscella K, Sousa F, Franks P, Henderson MC . How Medical School Applicant Race, Ethnicity, and Socioeconomic Status Relate to Multiple Mini-Interview-Based Admission Outcomes: Findings From One Medical School Acad Med 7565 May 75. [Epub ahead of print]

Author Profiles
Mark Henderson MD
Director of the Residency Program
University of California-Davis School of Medicine

AM carried out the design and prepared the manuscript. AS proposed the hypothesis, provided assistance in the design of the study, and participated in manuscript preparation. HM participated in manuscript preparation. MR had substantial contributions to concept and design, and provided assistance for manuscript preparation. All authors have revised the manuscript critically for important intellectual content and have read and approved its content.