 Step-By-Step Guide
Tips and Traps
Resources
Step-By-Step Guide
How to Order Additional Tests
Drs. Shah and Mendoza have asked you to determine which additional tests you would recommend to order for Brian Johnson.
The purpose of the additional tests is to gather information that we could not get in the interview or physical exam. These tests might require the use of technology and are typically more expensive than examining the patient manually. Also, some of these tests may have risks for the patient.
Getting Started
- Prepare to do your work on this task.
- Review Dr. Mendoza’s email and make sure you understand what you are being asked to do in this task.
- Download and briefly review the following file attached to his email:
- Additional Diagnostic Tests Form (blank) – This is the form that physicians at Lakeshore Hospital use to select which tests a patient will receive. In the first section, you will list the diagnoses you would like to test. In the second section, you will explain which tests you considered, which tests you chose, and why.
- Organize your team and create a plan for completing this task.
- It is up to your team to decide how to organize the work in this task. You may want to use the strategy of “divide and conquer” so that team members split up the work, or you may want to help each other cover the same ground. If you decide to divide the work, it is important for you to meet regularly to touch base on your progress and share the information you have found.
- Regardless of how you decide to break up the work, each team will need to submit a single, unified document to the mentor for review.
- If you need additional help organizing your team, please refer to the Teamwork section of the General Skills Resources located in the left menu.
- Read about the thinking process physicians use to test the diagnoses in a differential.
- Read section 4 of the Diagnosis and Treatment Process document: Test the first diagnosis to confirm or disconfirm it. This section explains the process a physician follows when testing the diagnoses s/he hypothesized in the differential. It will also be helpful to review the introduction to this document, which contains some important comments that are relevant to testing.
- For additional guidelines that physicians follow, see the Tips and Traps (above).
Completing the Testing Form: Section A – Diagnoses Considered for Further Testing
- Decide which diagnoses you think deserve further testing at this time. To do this, review each diagnosis on your differential and ask yourself the following questions:
- Is this a condition that the patient is likely to have?
- Does this diagnosis match well with the picture of signs and symptoms presented?
- Does this diagnosis match well with the patient’s health history, risk factors and demographic profile?
- Does this diagnosis match well with the patient’s story about the onset of the problem and with the patient’s mechanism of injury?
- Is there little to no evidence that would contradict this diagnosis?
If the answer to many of these questions is yes, and there is a good amount of evidence pointing to this diagnosis, you have justification to go ahead with further testing to confirm or disconfirm the diagnosis.
- Based on your answers to the questions in Step 1 (above), fill in section A of the template with the diagnoses you would like to test now and your reasons for testing each diagnosis. Regardless of how many you suggest be tested, justify your reasoning for testing each diagnosis at this point.
Completing the Testing Form: Section B – Tests for Each Diagnosis
- List the diagnoses that you chose in Section A in the first column of Section B. You might consider listing the diagnoses in the order of most likely to least likely, as in the differential.
- Review what you know and what you still need to know about the patient with regard to each diagnosis. Use DATA in Resources (above) to explore the Signs & Symptoms and Test Results about each diagnosis and figure out what you know and don’t know.
- Investigate the different tests available that will help you to obtain the information you need. Some of the tests relevant to the diagnoses in this case might include X-rays (radiographs), MRIs, bone scans, and CT scans.
- Use DATA (Diagnosis and Treatment Archive) to find tests that help in determining each diagnosis. For each test, consider:
- What is this test best at revealing?
- When is this test most effective at revealing the information?
- Are there any other tests that are better at revealing this information?
- Are there any health risks associated with the test?
- What is the cost associated with the test, relative to other tests you might be considering?
- For additional information on the advantages and disadvantages of tests, view the video in the Resources link (above).
- Decide which test, if any, will be best to order at this time.
- Remember, you should use the test with the least financial costs and health risks that will work sufficiently to give you the information you need.
- Based on your decisions in the steps above, fill in Section B of the template for each diagnosis. Remember to thoroughly address the topics in all four columns:
- Tests Considered
- Tests Ordered
- Purpose of Each Test Ordered
- Reasons for not Ordering Other Tests
Take note for yourself about what path you will take if the test results you receive are inconclusive; you will be given another chance to order more tests if you haven't gotten the information you need.
- Review the form to make sure it is complete, accurate and coherent.
Meeting to Exchange Feedback
- Meet with your cohort (made up of all teams participating in the rotation) to discuss your findings and ideas. You will be assigned one or more sections of the form at the beginning of the meeting; your team will present your key ideas and lead the discussion of that section with the cohort.
- After incorporating any feedback you may have received during the cohort discussion, submit your work to your mentor. Be sure to save all of your work, regardless of whether you submit it to the mentor.
Tips and Traps
Refer to Case 1, Task 1.3: Critique of Additional Evidence for tips and traps related to recommending additional tests.
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Diagnosis and Treatment Archive - Sports Medicine
What are the reasons for and against running an x-ray?