Differential vs Rule out Diagnosis

[Anxious20]

What exactly is the difference between differential dx and rule out dx? Examples would be helpful! Thanks 🙂

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[erg923]

What exactly is the difference between differential dx and rule out dx? Examples would be helpful! Thanks 🙂

nothing

 

[Anxious20]

LOL thank you! That explains why I can't find the answer online...

 

[smalltownpsych]

I agree with erg that there is really no big difference and it is probably fine to use them interchangeably, but I personally use the terms for different reasons. Rule out is more when I am trying to determine whether patient meets criteria for a specific diagnosis whereas differential is when I am trying to determine if it is this dx or that dx that have some overlap.

 

[bcliff]

I don’t typically use the term differential. I instead more commonly use “rule out x” if curious whether the person does or does not meet diagnostic criteria or “rule out x vs. y” if curious what diagnostic label best fits the presentation.


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[PsyDr]

IME, sometimes "rule out" is code for "I don't want to deal with either getting the information necessary to make the diagnosis, or I don't want to deal with the pain in the ass of arguing with this patient disagreeing with this diagnosis.".

 

[AcronymAllergy]

IME, sometimes "rule out" is code for "I don't want to deal with either getting the information necessary to make the diagnosis, or I don't want to deal with the pain in the ass of arguing with this patient disagreeing with this diagnosis.".

This. I'll sometimes list a rule-out if I suspect a patient has a condition tangentially related to my evaluation, and I gathered some amount of information to support its presence, but that wasn't the focus of the referral and that I didn't evaluate in-depth. Or for a personality disorder, which I generally don't diagnose after a single session. Although if I don't have enough information to at least broadly support a diagnosis, I don't list it. Instead, I discuss it in my summary.

I'll list differentials for suspected etiologies, but typically not for diagnoses. Although I suppose that technically with the DSM neurocognitive disorders, the etiology is in the diagnosis.

 

[Anxious20]

Thanks for everyone's input!!! I really appreciate it!

 

[bcliff]

In inpatient/bx med settings, it’s not always feasible to get enough info to rule-in/out dxs definitively (especially at intake) -- IMO, in these settings, R/Os can allow for a relatively wide net to be cast at intake that can then be narrowed via serial assessments. I think it mirrors the reality of the situation (e.g., conceptualization evolves in light of new info) and allows other staff to have an idea of what’s going on (without prematurely committing to a diagnostic label), which I like (especially if there are fluctuating medical/cognitive issues that may better explain psychological symptoms).

 

[Kadhir]

I've never really thought about this, but I don't use "rule-out" as a diagnostic descriptor in my npsych reports, but do use this in my conceptual narratives. I have a differentials list that I've started to number and rank in terms of etiological likelihood or amount of contribution to the clinical picture based upon my conceptualization.

 

[smalltownpsych]

I think that it also matters what the context is. If a patient has been referred for additional testing to clarify diagnosis, it might be a bit silly to still have rule-out dx'es listed; whereas, when seeing a patient at 2:00 am to assess for suicide risk, rule-out diagnoses make a bit more sense. Also, I always use the term rule-out in documentation. I tend to use differential when conceptualizing and communicating. Don't think there are any hard and fast rules for how to do this. For instance, I have not had an insurance company deny because a dx was a rule-out.

Another related term is provisional. How do you all use that? i seem to recall something in DSM-IV about that, but I could be mistaken. On a related note, I wonder if they should include a few more practical questions like this on the EPPP.