As you may remember, determining the differential diagnosis is only the first, albeit important step toward solving the problem. At this point, we order one or more tests to get 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. At Lakeshore, we prefer to be selective and streamlined in the amount of testing we order; we try to order only the tests we need to make an accurate diagnosis without adding unnecessary costs and risks.

Ordering Additional Tests
This time, rather than critiquing another intern’s ordering of tests, you will offer input on what tests to order. You will look carefully at your newly updated Differential Diagnosis, and determine what diagnoses to consider for testing. I have attached a template which we use at Lakeshore to order tests. Using the differential diagnosis you have developed for Jenny, here are some basic criteria which determine the inclusion or exclusion of a test:

• Is this a condition the patient is likely to have?
• Is this condition important to treat in order for the patient to fully recover?
• Can this diagnosis be tested fairly easily and inexpensively, with minimal risk or discomfort for the patient?

Based on this analysis, you will submit your recommendations for additional testing for Dr. Shah to review. Good luck. I’ll check in with you again soon.

Sincerely,

Lee Mendoza, M.D.