Task 1.4: How to Revise the Differential Diagnosis

Once again, use the step-by-step instructions that follow to analyze the results, draw conclusions and incorporate this information into your differential diagnosis.

• Please note: Though this may seem to be an unusually protracted case, it is not uncommon to go through multiple iterations of the diagnosis and testing process before a true diagnosis is identified. This is particularly true in the field of infectious disease, where the source can be elusive.

Getting Started

1. Collect your information to begin the analysis. You will need to reference your earlier drafts of the differential diagnosis throughout the task.
   
   
2. Carefully review the email from Dr. Campbell to become familiar with the new information she has provided, along with the goals of this task.
   
   
3. Review Ella’s test results.
   • Work with your teammates to determine the best approach to tackling this difficult case.
     
4. Organize your team to do the work.
   • If you need a refresher on getting organized, refer back to the step-by-step in Task 1.
     

Revising the Differential Diagnosis

1. Return to the test results sent to you by Dr. Campbell and evaluate them.
• Did the test results diverge from what you expected to see? Discuss any difference with your teammates.
  
  
• Now that you have come to the end of the anticipated test results, it is important to remember that all the evidence you have can be taken as a kind of test result.
  • For example, how has Ella responded to the medication she has already received? What information does this give you about any diagnoses that you have been treating?
    
    
2. Move systematically through the differential diagnosis document, making changes where they are needed due to the test results. As always, keep your old version. This may be an especially good time to take a hard look with your teammates over the history of the diagnosis, to understand the entirety of what you have learned about Ella.

1. Be sure to rule out any diagnoses that are no longer viable based on the current test results.
   
   
2. Remember, one test may be more accurate in detecting some diagnoses than others. You will need to do some research using DATA in Resources (above). For each test used to uncover information about a diagnosis, you need to find out:
   • Does a negative result on this test usually rule out this diagnosis with near-certainty?
   • Can abnormal results sometimes be difficult to see?
   • Does this test require time to pass before it will show an abnormal result?
     
     
3. Be sure to support your conclusions with evidence from the tests and your own deductive reasoning. Discuss any factors that you think should be given more or less weight in this decision.
   
   
1. Next, decide whether you need to change the ranking of those diagnoses which were not investigated further through testing. Ask yourself:
   • Does the current evidence for (or against) this diagnosis still justify its ranking in the differential?
     
     
   • In light of other diagnoses that may have changed in likelihood based on test results, has the relative likelihood of this particular diagnosis changed as well? If so, is it more or less likely than it was before?
     
     
2. Check to make sure you have reviewed all of the diagnoses in your differential.
   
   
3. Finally, address Dr. Campbell's question about medication. Ask yourself and your teammates the following questions before including your medication recommendation in your email to Dr. Campbell:
   • Has Ella responded to the current medication?
     
     
   • Has the current medication been given adequate time to work against Ella's infection?
     
     
   • Are there any other diagnoses that seem more likely and where medication might be called for?
     
     
   • If there is other medication that may help in the case of an alternate diagnosis, are there any risks of side effects to that medication? Weigh all the considerations before determining whether to change Ella's medication or not.
     

Meeting to Exchange Feedback

1. Meet with your cohort to discuss your findings and ideas. Your mentor will assign your team one or more diagnoses at the beginning of the meeting. Your team will present your key ideas and lead the discussion of those diagnoses.
   
   
   • Jot down notes to record what you gain from the discussion. Write any answers you found to the questions you and your teammates posed in the beginning of this task. You may also note down any questions you still have about analyzing tests and making a diagnosis.
     
     
2. After incorporating any feedback you may have received during the discussion, submit your work to your mentor. Be sure to save all of your work, regardless of whether you submit it to the mentor.
   

Diagnosis and Treatment Archive (DATA) - Mystery Case

Diagnosis and Treatment Process
This document describes the process that health care professionals typically use to diagnose and treat their patients.