SPIT the Diagnosis

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SPIT the diagnosis Why A differential diagnosis is a key step in clinical thinking. But we may not be the first person to see the patient, and diagnostic labels have often already been given to them. While in many cases diagnoses will be right, we need to ensure we have enough evidence to agree with the diagnosis and to feel comfortable that other possibilities are excluded. In other cases, the presentation evolves, diagnostic clues may have overlooked or the problem is simple undifferentiated. What SPIT is a memory aide for organising your thinking around a differential diagnosis. Consider which diagnoses under each of the following headings, even if they seem unlikely at times. Serious Probable Interesting and Treatable How A memory aide might seem simple. But if we take the time to reflect on a differential diagnosis in this way it challenges us to consider all possibilities and be explicit about our clinical reasoning for including or excluding possibilities. And this is something we can all learn from. On a ward round, on a shift or in an outpatient encounter, for every patient regardless of how simple their presentation may be challenge yourself to list one diagnosis under each of the headings. It may change your thinking about a patient… The infant with bronchiolitis… Serious = cardiac failure Probable = bronchiolitis Interesting = airway malformation Treatable = pneumonia http://www.pemfellows.com/blog/the-med-ed-toolbox-spit/ Reference: Society for Academic Emergency Medicine Meeting 2013: Guth T, Lovell, E, Shah, S, Epter, M. “Taking Advantage of the Teachable Moment: A Workshop for Efficient, Learner-Centred Clinical Teaching”. .

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