reply to Jeremy S:
The formulation of a differential diagnosis is a key element in practicing as a clinician. In the differential diagnosis processes the healthcare provider must be a detective and using the various assessment tools available determine the illness most likely affecting the patient. Despite the incredible importance of this process, diagnostic errors are a significant part of medical errors frequently due to a missed diagnosis (Kämmer et al., 2021). In light of this, the process used is of vital importance. The first step in the process is history-taking. In this step, the healthcare provider listens to the patient’s complaints and symptoms and asks questions to begin to formulate a diagnosis. This initial history-taking can be the initial stimulus to begin formulating a list of potential diagnoses (Centor et al., 2019). The benefit of beginning to formulate the list based on the patient’s history is that it gives a place to start. Starting the list by conducting a physical assessment or looking at lab work would be too broad a focus, but the patient telling us about their current health is a strong start to formulating a list. Following the history taking the provider can then perform a hands-on physical assessment which will be beneficial to further narrowing the symptoms. For example, if a patient has a complaint of abdominal pain then inspecting and palpating the abdomen would provide important information on whether the prevailing diagnosis is feasible or not. The risks of the physical assessment are low, but the healthcare provider must keep in mind atypical presentations of a disease. Another benefit of the physical exam is that it may change the nature of the complaint. If the patient had been complaining of chest pain, palpating the chest and abdomen may indicate the pain is really in the abdomen and not the chest which would lead to a different diagnosis. Lastly, the healthcare provider should look at relevant diagnostics studies such as imaging and lab work. The benefits of these are they can be incredibly specific to a certain disease or illness. For example, if a patient is complaining of flu-like symptoms then a positive flu test would be a good clinical indicator the patient has the flu. On the other side, research shows that there is a tendency to overorder clinical tests which can increase the cost of care dramatically without improving clinical outcomes (Cook & Décary, 2020). Overall, each of these three steps within the differential diagnosis process is important but none can exist in a vacuum, and each can guide the implementation of the other processes while helping to focus the list.
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