How to Create a Differential Diagnosis (Part 1 of 3)

Part 1 of a 3 part video series on how to create a differential diagnosis from a patient's presentation. Covered topics include identifying the key features of a presentation, creating a problem representation, use of semantic qualifiers, and the components of a solid and practical differential diagnosis.

[@thawornlorga1972]

Great stuff taught by smart professor who makes difficult things easy to understand and follow. Thanks.

[@imissmydeadcat.74]

The core concepts of efficiency, justice, and freedom can be applied to generating any type of wise understanding that requires critical thinking. You're essentially sourcing the origin of the patient's life to the material components necessary for the soul to activate the clockwork of its dimension. If a person isn't healthy, you start with some of the most obvious and easy observations as to why this is. As you start to process these leads more and more, you can begin to experiment with a full theory on what's actually wrong in terms of the larger perspective. The reliable solution is always to stabilize as needed. It's really just a test of a person's comprehension of biology as it composes the greater scheme of life as a whole. But, true wisdom can and does unite ALL forms of understanding.

[@StrongMed]

Part 2 up tomorrow. Part 3, the day after...

[@zyzzyva57]

Nice to appreciate the work of Dr. Gregg House

[@balajibramhan]

Thank you soo much for taking time from your busy schedule and making these videos for us..our clinical rounds have started and this was exactly what i was looking for.. may god flood you and family with showers of blessings so indebted to you . :-)

[@ghaffasa]

I concur with the previous positive feedback! Your videos fill out the vital parts left out in medical school! Also, thank you very much for your reply to my question regarding acid-base-disturbances! My overly-zealous attempts to understand the copenhagen model have come to and end.

[@rubywilliams6466]

Thank you Dr. Strong. This was the most detailed explanation of a Differential Diagnosis that I have ever received. Very easily understood and relatable.😀💯

[@Zerotu11]

3:05-acquire data 5:35-identify key features 6:24- create problem representation 11:26-adopt a framework 16:06-apply key features

[@andrestahlhofen4353]

Thanks for your efforts and time that you put into these projects. I have watched almost all of the playlists and it's such great content. Thanks for all the teaching! I was wondering whether you'd be able to do a video/series on determining/assessing clinical disposition as I often find this topic to be difficult in practice as some clinicians seem to value some factors over others which is not always following a particular logic. I was hoping to learn more about this topic and develop a more structured approach when assessing a patient for disposition. Kid regards :)

[@dinegoko]

Thanks!!! Your videos fill out the gap left out in medical school.

[@hermetichector]

Awesome! Thank you for taking the time to make this video

[@drhanyelbanna8082]

wonderful work you helped me and who does not thank people does not thank Allah so thank you very much go on may Allah bless you

[@juancho1309]

Your videos are awesome!!! Thank you so much for taking the time to make these.

[@mahdifreealgerie9351]

Thank you,i'm learning every day many new information about diseases but when a patient come to me i become confused because of the different diagnosis so it's difficult to remember all of them

[@RN1BSN]

Nice!!!

[@lukaspreis4736]

I have been looking for a practical approach to clinical reasoning. Thank you very much!

[@Doctorsuit]

Hello Dr strong , your videos are amazing cto improve clinical thinking could you advice on how do I decide which framework to choose, is there a general rule of thumb. Because the framework could be anatomical, physiological , organ based. If you could answer that question it would clear a big dilemma

[@blessingokpo4150]

thank you so much doc. Very explanatory and informative.

[@lizbethmcewan]

Dear Dr. Strong, This is probably an obvious question, but how can I learn more Clinical Syndromes? Is there a book? or is it perhaps experience in the wards? Thank you very much for the interesting videos that you upload. Karla.

[@curvedcut]

Amazing!

[@50filip]

I wish one of my profesors told me such an informations.Thanks

[@greenspace91]

Thank you Doctor Strong! Please suggest some books on clinical reasoning!

[@StrongMed]

There's not one perfect book on clinical reasoning, but my 3 go-to recommendations: 1. Symptom to Diagonsis (Cifu, Altkorn, and Stern) - Focuses on how to approach individual symptoms through 1-2 examples/symptom. Sort of like a textbook version of my "Approach to Symptoms" series. Doesn't really talk much about clinical reasoning as a separate discipline per se. Also focuses mostly on diagnostic reasoning. Good for preclerkship med students, and those at a similar training level in other fields. 2. Learning Clinical Reasoning (Kassirir and others) - The first ~1/4 is a pretty decent, introduction to the clinical reasoning process. The last ~3/4 are a discussion of specific cases. Focuses mostly on diagnostic reasoning. Good for clerkship students or interns (who have spare time for reading...). 3. Medical Decision Making (Owens and others) - It's not a large book, but it's as close as there is to a college-level type textbook for the discipline of clinical reasoning. There is no discussion of how to approach individual symptoms; The first handful of chapters is roughly similar in content to the first 1/3 of Learning Clinical Reasoning, but the rest of the book is relatively technical regarding decision science. Not a light read, but I don't know of another book that covers these topics at this level. Covers both diagnostic (i.e. what disease does this patient have?) and therapeutic (i.e. how should we treat this disease in this patient?) reasoning. Recommended only for those with a particularly strong interest in clinical reasoning and who are not scared off by some math (e.g. probability and basic stats).

[@greenspace91]

@@StrongMed Thank you so much for your reply! I will definitely look into those 3.

[@laurentiu244]

Excellent presentation

[@picfunmedicosis1187]

Really helpful

[@johnathanrendon4933]

TAKING DIFF EQ as an elective pre-med biochem major. My luck finding this channel :)

[@stevehawke9819]

What do you think about the book Frameworks for Internal Medicine (Andre Mansoor)? Or the book Symptom to Diagnosis (Scott Stern)?

[@StrongMed]

I have heard great things about Mansoor's book but have deliberately avoided looking at it because the similarities between its material and my ongoing video series, Approach to Symptoms, would make it impossible to feel like I wasn't copying him. I look forward to finishing my series so I can finally read it! I think Symptom to Diagnosis is a fine book for a discussion of specific common symptoms, but IMHO, it seems to focus too much on 1-2 diseases for each symptom rather than giving a broader discussion of a more complete list of common etiologies. Our clinical reasoning course previously assigned it as a required textbook, but we found that only a minority of our students read it, so we redesignated it as an optional resource, and now require students watch videos instead.

[@stevehawke9819]

@@StrongMed Thanks so much, Dr. Strong! That's helpful to know. At our med school, lots of students using Mansoor's book and a couple saying they liked Symptom to Diagnosis, but what do we know we're just students so it's good to hear your thoughts! I really like your videos so far and will try to stick to these.

[@celiojr3437]

Doctor, what medicine book do you use to create frameworks? I’m a medical student

[@StrongMed]

If you're asking what I personally use to create framework (for example, for my Approach to Symptom videos), it's a combination of UpToDate and review articles, with some influence from what I've found helpful in real life. On the other hand, if you're asking what I would recommend for medical students, I'd recommend Frameworks for Internal Medicine by Andre Mansoor - in addition to my KZbin videos, of course! ;) It obviously has an IM bias in the selection of frameworks, but there's a lot of overlap with common problem in surgical and ob/gyn patients.

[@celiojr3437]

@@StrongMed Perfect! I have Mansoor's book. It's very good. Congratulations, your channel is also amazing. I have promoted it to all my colleagues in Brazil. Because we have little about "systematic medicine" in the literature and your channel has helped me a lot. For me, a medical student, it's been so difficult, because I can't find systematic books like "symptoms and signs -> anatomical diagnosis -> syndrome diagnosis -> differential diagnosis -> disease diagnosis". Goodbye

[@franciscoramos3055]

Thank you

[@ajaymishra5375]

thanks. well explained

[@shammah98]

is that a palliative medicine textbook i see back there? awesome

[@StrongMed]

It is, or more accurately, it was - I got rid of all of those enormous textbooks when I changed offices - too bulky, and all of that stuff is on line now...

[@pinkcandy669]

None

[@jmacfarland1]

Is there anyway to print this powerpoint presentation?

[@StrongMed]

jmacfarland1 So sorry, I'm just seeing this comment now! If you are still interested, email me, and I am happy to send you a pdf copy of the presentation.

[@haiderissa163]

+Strong Medicine ...thanks for your great job...can I get your lectures as pdf and how?

[@StrongMed]

Haider Issa Sending me an email is best. My address is easily searchable on Google. (I avoid posting it in these comments out of the probably unfounded concern that it may further increase my already enormous volume of spam) I only have pdf versions of a subset of my videos, since many were created directly in Adobe Premiere and are extremely cumbersome to export into a printable format.

[@haiderissa163]

Strong Medicine [e-mail] this is my email...thank you so much.

[@duraivengatesan9674]

+Strong Medicine I love ur way of explanation.Your slides are awesome.can u mail me the pdf [e-mail] is my mail id.Thank you..

[@leulendalamaw153]

nice presentation thanks!!!!

[@varunnurav6912]

Dr. Strong, your videos are one of the best sources available here. Thank you for this valuable information. Could you make a video on test taking strategies for USMLE STEP-CK and on FEVER and how it helps in d/d. Thank You once again . Varun

[@StrongMed]

Varun, thanks for your message! Unfortunately, I would not be a good person to offer specific advice for USMLE, though I do have a video on more general advice for studying in medical school: kzbin.info/www/bejne/nGGZkmuXfa9-aZI

[@vicwen1240]

Thank you very much! A must at every medical school!

[@hartmanmadu6017]

Your videos on differential diagnosis are excellent!!! Is there a textbook that you recommend that also teaches differential diagnosis and gives multiple examples of cases that have differential diagnoses developed?

[@StrongMed]

+The-X-Factor Probably the best introductory textbook on clinical reasoning and differential diagnosis generation is "Symptom to Diagnosis: An Evidence Based Guide". It's not great, but it's the best there is. For people with more experience (e.g. residents / registrars), "Learning Clinical Reasoning" by Kassirer is pretty good, and very readable.

[@hartmanmadu6017]

+Strong Medicine Thanks a lot!!! I certainly enjoyed your videos because it really opened my mind as to how I should be thinking as a medical student. You should really consider writing a book about the thought process and the steps involved in developing a differential diagnosis. Send me a copy if you do, lol!

[@StrongMed]

***** Thanks, already working on a few too many books at the moment. Maybe someday?

[@waegie]

thank you

[@StrongMed]

Part 2 up tomorrow. Part 3, the day after...

[@jacquelinegabone782]

Thank you Dr Eric, do we have one on how to make Differential diagnoses base on imaging, when we are not provided with clinical history?

[@kylewalding2058]

As usual, Dr. Strong presents an extremely well-thought-out approach to an often poorly taught yet critical component of clinical medicine. I'm a third year now, but I'll repeat this series many times prior to my intern year. Thank you so much!

[@Zara_Luna]

Kyle. You will be a great Doctor :) I went to nursing school and we also had poor teaching on clinical reasoning. I also feel that nurses should partner more with doctors and learn how doctors think. I wished i worked as a scribe during nursing school. :) Thank you Dr. Strong for helping the community become better Doctors and nurses.

[@اشراقةحلم-ص6ل]

I want to thank you very much for bringing back the joy of learning to me!

[@palomavaldez3988]

thank you so much for this Dr.!! God bless.

[@davidsoto4394]

This video is one of my favorites along with the h&p video.

[@ethicsvideo4295]

Very helpful, printed copy would be helpful too. Thank you!

[@aelhamamy]

Sir, I look up to you. Thanks from the bottom of my heart!

[@Medicoinfoline]

Great doctor, your videos are full of information with great contents. Very valuable for audiences.

[@bensonchad]

Thank you for the clear and concise lecture. Very well done!

[@novu16]

hi doc I have a question, step two includes labs and other tests but shouldn't frame work come before the labs and tests so that we know what we trying to rule out and our labs well directed, am confused .."

[@dongmai578]

you are great !

[@debaguisso]

Hello, Dr. Eric, how are you? What semantic qualifier would you use for "severe" or "weakness" (I'm not a med stud, so my my question might probably be lame)

[@StrongMed]

As an adjective, "severe" might be considered a semantic qualifier in itself. However, the severity of a symptom is relatively unhelpful in making a diagnosis. In other words, the causes of severe abdominal pain vs. mild abdominal pain, or severe diarrhea vs. mild diarrhea, overlap enough that you wouldn't rule out a diagnosis just on account of severity.) So I wouldn't typically use "severe" as a semantic qualifier in practice - with the exception of patients who report a pain is literally "the worst pain I've ever felt" or when they rate a pain as a "12" on a 0-10 scale, in which case it's probably better to just quote the patient verbatim. Or if describing weakness, if it's really profound, you could probably use the term "paralysis" instead of "weakness" to convey that. For weakness, relevant semantic qualifiers potentially include unilateral vs. bilateral; proximal (i.e. knees/hips/shoulders) vs. distal (ankles/wrist/fingers); progressive (worsening over time) vs. fixed (unchanging); focal (i.e. one limb) vs. diffuse (i.e. all limbs); painful vs. painless. It's not paired with an opposite, but "ascending weakness" (or often "ascending paralysis") is a term used to describe weakness that starts in the feet (i.e. foot drop), then involves the quads/hamstrings, then the hips, and so on.

[@nu.wa.n]

This is brilliant. Something sorely missed from my med school education haha.

[@SadamKhan-nn4vy]

great .... Need ward round video lectures

[@ahmaddawar2760]

Well explain really appreciate your kind effort keep it up 👍

[@JohnDoe-jo6iz]

You are a great great teacher. Thank you

[@markofharvey]

Where are parts 2 and 3? Thanks for all your videos.

[@Sherirose1]

Thank you so much.

[@maxlichtenberger7447]

so nice thank you !!! is there a good textbook for diagnostic frameworks?

[@StrongMed]

Specifically for an approach to learning medicine that is centered around diagnostic frameworks, you probably can't do better than Andre Mansoor's Frameworks for Internal Medicine.

[@maxlichtenberger7447]

Strong Medicine thank you❤️

[@nayelakawsar8935]

Thank u so much.

[@georgesurfer30]

Thank you!

[@naspinwall]

Thank you. This is awesome

[@hyacinthromulo]

You're the best! Dr. Eric :)

[@895792]

Thank you.

[@lopezcora]

Im here..because I'm trying to find a way to write about the 3 various things that occurred. re: my health... ..beginning a year and 8 months ago..I have been to the doctors 3- 4 times and the e.r. 3 times.. ..it begin( a year and 8 mos ago) when a fly landed above my lip. 5 days after..I awoke with pain in ear..blood and temporary hearing loss. (there had been ants on my bed and one was stuck on my face..to a honey mask). went to.e.r. and didnt relate the fly incident until a week after the boil developed above lip in spot where fly landed.. which was a month later..i was fatigue and had boils on my headand above lip and i googled " herpes " and finally.. " what happens if a fly lands on you" and i was surprised and also anxiety..(trouble breathing in bed and anxious) so i felt too much time passed so it was urgent and when i went to e.r. i saw the same dr. .. when i told her about the boil and a fly landed above lip.. she laughed and said " this isn't a thirld world country " and " no".." have you left the country"? and finally gave me literature for " delusional parasitosis" and a prescription for benadry".. allergy meds...anyways.. after that visit..ive gone to the primary doctor and each time..its a new doctor and Each time I try to address the health issues..they ask me " if ive been evaluated .." psych evaluation".. :-meanwhile... additional incidents that pose a potential health hazard and my health has deteriorating rapidly... additional incidents : ( 10 mos ago)dog scratches forearm .cutting through and a rash erupted.. scratch accidentally touched a gnat and worm infested palm tree soil.. ..and a fungis gnat problem.. and a cat dug 3 claws in my waist ( 4 moss ago) ....currently my vision is 80 in right eye.... fatigue..forgetful .. left arm/ shoulder is painful..cant bend..extend ..it affects my hand strength ... ( it took 10 mos before the boils on head that would change locations to go away..after home remedies and otc pinworm medicine.etc.) and then the dog scratch. after that..my skin hasnt been the same.... for 10 months..now.. lil tiny pepper ..splinter.fleas..idk what it is..but it comes out of pores and retracts.its bluish underneath a magnifying glass.. my eyes itch and sting. ..surface of skin looks frosty or moldiy..and the fatigue os the worst feeling .. along with not knowing if its contagious.

[@scarred10]

PRAISE BE THE LORD, someone who can speak English understandably.