When you go to see a medical professional because you are not feeling well, you expect the professional to figure out what is wrong with you, if possible, and make you better. The differential diagnosis is a big part of that process.
The first thing that happens in a medical encounter is getting the patient’s chief complaint. Why are you here? What is bothering you?
The next thing that should happen in a typical encounter is the recording of the patient’s vital signs. Temperature, pulse rate, blood pressure and respiration rate. Sometimes the vital signs alone provide the key to the patient’s problem. In every event, however, they are an important piece of information which must be taken and considered.
After the vitals are done and the provider has reviewed them and the chief complaint, it is time for a history and a physical examination. It is during the history that the provider first begins to formulate a mental list of possible explanations for the patient’s complaints. The list of possible explanations is what the medical profession calls a differential diagnosis. It may shorten or lengthen as the interaction with the patient proceeds. It may require testing to eliminate some possibilities or to confirm others.
When taking the history, the provider should ask questions directed to the possible explanations on the differential diagnosis. Importantly, however, the provider must avoid jumping to conclusions. She or he must keep an open mind. Once we believe we have the explanation for a problem, it is human nature to look for signs that reinforce our conclusions and to ignore signs that counter them. As long as the provider can keep an open mind, she or he will be open to all information, not just that which supports one possible explanation.
After the history comes the physical examination. It should be thorough and not just directed to possible explanations for the complaints. Even when there is an obvious condition, providers should be cautious and keep in mind that a patient may have more than one illness or medical condition. In other words, just because a patient has pneumonia does not mean that the patient does not also have a pulmonary embolism. I have seen this form of malpractice too many times to count.
At the conclusion of the physical examination, the provider may order various tests to assist with the diagnosis.
All along the provider should be updating the differential diagnosis and ranking the possible diagnoses in order of their likelihood. The differential may contain some diagnoses that are more serious than the others. Some may even be life-threatening. Life-threatening possibilities must be ruled out, even if they are not very likely. Sadly, I have seen many cases in which a life-threatening condition was on the differential diagnosis and was not ruled out before the patient was sent home. And, of course, if I am seeing this case, it is usually because the life-threatening condition was the explanation all along and the patient either died or suffered a serious injury due to the failure to correctly diagnose the problem.
When all is said and done, the provider will hopefully have identified the problem and offered a treatment solution. Even under the best of circumstances and with the best providers, the explanation for the patient’s complaints may still be unclear or the provider may have reached the wrong conclusion. This is where you as the patient come in.
You must keep in mind that the health care provider may make mistakes. You must keep in mind that the situation may change, even within minutes of leaving the provider’s office or leaving the emergency department. All too often, I see cases in which patients were sent home and either did not get better or got worse and did nothing. Do not be shy. Go back to the hospital or to another hospital, if you are not getting better. In every malpractice lawsuit I have ever seen, the healthcare providers do the same two things: (1) They deny they did anything wrong, and (2) They blame the patient for not getting prompt help when she or he did not get better or got worse. Juries are quite receptive to both of these arguments. If you are proactive and go back for help promptly, you may avoid the kind of injury that ends up in the hands of a jury.
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