For pts that present for a second time after the intial dx and tx

[TheSeanieB]

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For pts that present for a second time after the intial dx and tx, what do you find to be more helpful?

 

[FutureInternist]

Patient education, so they know why taking their meds is important

 

[gutonc]

For pts that present for a second time after the intial dx and tx, what do you find to be more helpful?

Where do you come up with this stuff? And I don't mean that in a "ha ha ha...you so crazy" sort of way.

 

[Dral]

If pt is compliant, usually different tx or a bx.

 

[Smurfette]

I don't understand the question without context...

You talk to the patient and determine what, if anything, is needed. Depends on the scenario. They may need reassurance, more education, or additional work up.

 

[TheSeanieB]

I ran out of space in the title. What I am asking is, "What do find most helpful in re-evaluating a patient when their initial diagnosis turns out not to be correct?"

 

[ThoracicGuy]

I ran out of space in the title. What I am asking is, "What do find most helpful in re-evaluating a patient when their initial diagnosis turns out not to be correct?"

There's no right or wrong answer. This is just tailored to each individual patient.

 

[JacobMcCandles]

I ran out of space in the title. What I am asking is, "What do find most helpful in re-evaluating a patient when their initial diagnosis turns out not to be correct?"

In my experience, finding the correct diagnosis is most helpful.

 

[Gastrapathy]

CT scans, tagged WBC scans, and an ID consult. You may not get the right answer but you'll feel like you did.

 

[michaelrack]

Referral to the local university medical center. If you are a doc there, then referral to the chairman of the dept.
If you are the chairman, then referral to Mayo Clinic.

 

[ThoracicGuy]

CT scans, tagged WBC scans, and an ID consult. You may not get the right answer but you'll feel like you did.

How about a SED rate?

 

[Gastrapathy]

How about a SED rate?

Bingo.

And of course pan-endoscopy.

 

[gutonc]

You guys are ignoring the most important test (and ultimate grope-o-gram):

PET scan

 

[evilbooyaa]

If your first diagnosis is not correct? Then you diagnose something else based on a combination of H&P/tests/etc.

What are you really getting at w/ this thread, OP?

 

[TooMuchResearch]

In my experience, finding the correct diagnosis is most helpful.

Of course! It's so obvious. Diagnose then treat! I have been using the much less popular method of treat, then diagnose.

 

[jerseytrash]

Get an echo obviously

 

[colbgw02]

Of course! It's so obvious. Diagnose then treat! I have been using the much less popular method of treat, then diagnose.

 

[neurodoc]

I ran out of space in the title. What I am asking is, "What do find most helpful in re-evaluating a patient when their initial diagnosis turns out not to be correct?"

That's very different from the original question...The original question did not assume that the diagnosis was incorrect. Just because a patient comes back to see you (even with persistent symptoms) doesn't mean your diagnosis was wrong. Your diagnosis may be correct but your treatment isn't working...or the patient may not be following your treatment...and other possibilities.

If your diagnosis is wrong, how do you know that? Lots to think about there...

Of the 4 choices listed, repeating the H&P and re-evaluating your differential diagnosis seems the best course. This re-evaluation would then suggest the best "further studies" or specialist referrals to request.