diagnostic medicine

[dfk]

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i really hate to ask this, so, i will...
i know the reality is benign on the show "house",
but i'm just wondering if the way they rattle off
differentials is, uh, common or even, uh, possible..
i mean, these guys come out of left field with their
'superb' memories/knowledge..
are people (read docs) really this adept, quick and
readily intelligent?
btw/ forgive my ignorance in asking.. thanx~

 

[orientedtoself]

sorry dude, there is no such thing as a diagnostician. or the tooth fairy or santa claus. i cannot stand to watch house, even for two seconds, because it drives me up the wall how wrong it is. if my husband is flipping channels and he stops on house, i have to leave the room.

 

[dfk]

i know. i get it.
i was just wondering if people can/do
actually think/proffer info in such a manner..
that's all..

 

[smq123]

i know. i get it.
i was just wondering if people can/do
actually think/proffer info in such a manner..
that's all..

Can people spit out diagnoses without any hesitation, like they do on House? Not really. It takes a while to think back and dredge it up from your memory.

Do they sometimes go around in a circle, and each person has to contribute another diagnosis to the differential? Yes, sometimes. Some internal med attendings LIVE for these sessions.

When they have these sessions, are they sitting down in a nice conference room (like they are in House)? No - they're usually held while everyone is standing around in a hallway, dodging janitors and nurses.

I really hated sessions like the ones that they have in House, though. They take up a LOT of time, and for me, were less enjoyable than self-flagellation would have been. And while they may serve a useful purpose, once someone starts throwing out things like "SARS" or "AVIAN FLU" for a chief complaint of "cough," that's when you know you've gone too far.

 

[dfk]

thanks smq..
i figured it isn't the norm to be able to recall like 90% of whatever can be applicable to the moment...

 

[Strength&Speed]

basically you should know the top 5 or so on the differential. In shows like House...they seize on differential #22 immediately. Yeah...it might happen, but you are a douchebag if you ignore 1-5....which will encompass 99% of the cases.

 

[Blade28]

When they have these sessions, are they sitting down in a nice conference room (like they are in House)? No - they're usually held while everyone is standing around in a hallway, dodging janitors and nurses.

So true!

And while they may serve a useful purpose, once someone starts throwing out things like "SARS" or "AVIAN FLU" for a chief complaint of "cough," that's when you know you've gone too far.

I published a paper on physicians' lack of knowledge of SARS. 🙁

 

[buckley]

Ok, ok, I must admit I'm a fan of House. I think Hugh Laurie is so sexy...hahaha! I loved him in Stuart Little. Dr. Jekyll and Mr Hyde appeal...something like that I guess! Hahaha. There are stuff wrong there, but really, don't we all watch for the entertainment? 🙂

Maybe not to the extent as in House, but there are "gods" out there who just seem to see through a huge amount of clinical data and tell you, "well, isn't this a classic case of ____?" Then when you look it up and think about it, you go, "Awesome! It is a classic case of ___!" It's almost like a scripted TV show too.

It's also a skill to say when it cannot be a particular differential, like an attending cutting your considerations to pieces. And you're Rudolph red.

Pathologists and radiologists seem like "diagnosticians" if they do exist.

 

[doc20]

House isnt just a diagnotician, He is also Infectious Disease specialist,
and yes when attendings do rounds with fellows there are just as many differentials bumping around as on House.

 

[johnnywalker]

don't forget cardiologist, he's done echos and cather izations...and always successfully rules out lupus, so also rheumatology as well?

 

[Miami_med]

Isn't it obvious that House is an internist, pathologist, pediatrician, infectious disease specialist, cardiologist, neurologist, radiologist.

He's too cool to wear a mask in the OR, and though he's not a surgeon, he knows more about surgical disease than all of the surgeons in his hospital.

Oh yeah, even with all of these certifications he's also never heard of a CMP or a lab tech, so he often is surprised with info like, "THE KIDNEYS ARE FAILING!!!", when he never actually looked at a BUN/Creat, and all of his fellows have to run the lab tests that even I as a third year medical student can get someone else to do at a county hospital. (That was a run-on wasn't it?)

 

[johnnywalker]

...

 

[Tired]

Diagnostic Medicine = Internal Medicine with great board scores

 

[gutonc]

thanks smq..
i figured it isn't the norm to be able to recall like 90% of whatever can be applicable to the moment...

Actually, 90% of what is applicable to the moment in the real world (at least in IM) is about 3 things, to get to 99% of the cases, you may have to have 5 things on your differential. The rest is just intellectual wankery...except when it isn't. So yes as a medicine R2 (and, honestly most M3 can do as well) I can easily rattle off 10 things on the differential for chest pain, cough, abd pain, diarrhea, fever, etc. But having those other things in the back of your mind (or in your accessory brain, AKA uptodate) will get you that last 1%.

 

[Strength&Speed]

Actually, 90% of what is applicable to the moment in the real world (at least in IM) is about 3 things, to get to 99% of the cases, you may have to have 5 things on your differential. The rest is just intellectual wankery...except when it isn't. So yes as a medicine R2 (and, honestly most M3 can do as well) I can easily rattle off 10 things on the differential for chest pain, cough, abd pain, diarrhea, fever, etc. But having those other things in the back of your mind (or in your accessory brain, AKA uptodate) will get you that last 1%.

I agree. For evidence I agree, see my above post, which is virtually identical to this one.

 

[MSHell]

Diagnostic Medicine = Internal Medicine with great board scores

Awesome. 👍