 Step-By-Step Guide
Tips and Traps
Resources
Step-By-Step Guide
How to Choose Diagnostic Tests
As the next step in assisting Dr. Shah with William Rand’s case, you will select one or more diagnostic tests that you think should be performed at this time. You must choose tests that will help to confirm or disconfirm the diagnoses. The following step-by-step guide will help you do your work.
Getting Started
- Get prepared to do your work in this task. Go to the email sent to you by Dr. Mendoza, and download the attachments. You will need the following throughout the task:
- Additional Diagnostic Tests Form- 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.
- Carefully review the email from Dr. Mendoza to become familiar with the goals of this task.
- Review relevant material on diagnostic tests in DATA and the Diagnosis and Treatment Process document, both available in the Resources link (above).
- See the material in DATA on diagnostic tests. Remember test related materials are presented as clinical findings, so to learn about a test you must look it up by test result. (e.g. The clinical findings page on Abnormal MRI will include information about the MRI test.)
- Reread section 4 of the Diagnosis and Treatment Process document: Test the first diagnosis to confirm or disconfirm it. This section explains how a physician tests the diagnoses in the differential.
- Organize your team to complete the 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, see the sections on Teamwork and Project Management in the General Skills Resources in the left menu.
Completing the Testing Form: Section A – Diagnoses Considered for Further Testing
- Decide which diagnoses you think are worthy of 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.
- Is this a condition that is important to treat, in order for the patient to recover fully?
- Is this a condition that will cause lingering symptoms and fail to heal properly without appropriate treatment?
- Is this a condition that will need to be treated and resolved before the patient can return to sports safely? Could it be aggravated by activity or could activity cause additional damage?
If the answer to these questions is yes, you will need to confirm or disconfirm it with more certainty through additional testing.
- Is this a diagnosis that can be tested fairly easily and inexpensively, and with fairly low health risks for the patient (for example, it’s non-invasive)? Use DATA in Resources (above) to find out more about each diagnosis and what tests might be required to gather additional evidence.
- 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 teammates to discuss your findings and ideas. Take some time for each person to share highlights of his/her work.
- Come to a consensus on the Additional Tests Form.
- As a team, create a deliverable that you can agree upon, to submit as a group deliverable.
- To help you, see the resources on Teamwork, especially the articles on collaborative group work and collaborative writing, in the General Skills Resources in the left menu.
- Submit both your individual work and your team document to your mentor. Be sure to save all of your work, regardless of whether you submit it to the mentor.
Tips and Traps
There are no new Tips/Traps for this task. For guidance on ordering additional tests, refer back to Tips and Traps for Case 2: Skateboarding Slip-up. The Additional Evidence task is relevant here.
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Diagnosis and Treatment Archive - Sports Medicine
What are the reasons for and against running an x-ray?