I’ve reviewed your diagnosis of Mr. McGrath. Based on patients I’ve seen in the past, I think liver cirrhosis is the most likely cause of Mr. McGrath’s symptoms, so I want to pursue it first.

Our Hypothesis: Cirrhosis
I went ahead and ran a full set of liver-panel tests, as well as a CAT scan; the results are attached to this email. I’d like you and your colleagues to take a look at these results and see if they help confirm our diagnosis of cirrhosis of the liver.

Cause of the Cirrhosis
Next, assuming that Mr. McGrath’s liver is cirrhotic, I’d like you and your colleagues to determine the underlying cause. His liver didn’t begin to deteriorate on its own. I want you to research the possible causes of cirrhosis and determine what tests we can run to confirm the cause.

Testing Other Body Functions
Lastly, it’s common for liver cirrhosis patients to have both kidney malfunction and internal bleeding. Please order the appropriate tests to see if Mr. McGrath’s kidneys are functioning properly and to see if he has any internal bleeding.

Your Task
You and your colleagues should draft a diagnosis plan that will:

• Confirm our initial hypothesis of liver cirrhosis: How do the liver- panel test results confirm the diagnosis? Does the CAT scan confirm the finding?

• Diagnose the underlying cause of the liver cirrhosis: Something made it cirrhotic; your diagnosis plan should test for what that “something” is.

• Order the appropriate tests to determine a) whether his kidneys are working properly, and b) if he has any internal bleeding.

In your final written report, I want you to justify each action you take by stating why you decided to take it, and what you hope to find out from it.

Mr. McGrath may be a very sick patient; your diagnosis plan is critical in determining how we proceed to treat him.

Thanks,

Dr. Jordan Casey
Attending Physician