Good question, To make a list of criteria for what is “reasonable threshold” for each disease, given each symptom, and each test, such a thing would probably be more trouble than it’s worth for the simple in-the-room tests, but I’m sure they exist for expensive/harmful things like biopsies or CT scans. In this case, I think the presentation exceeds the threshold to consider a stroke, but not enough to do costly tests.
In general, we’re drilled with the general algorithm:
1) a long list of “triggers” that says, “if you see this/these symptom(s), you should immediately put dangerous diseases X, Y, and Z on your differential.” e.g. disorientation and slurred speech, the word “stroke” should AT LEAST enter your mind temporarily.
2) Then, rule-out X Y and Z with cheap and easy tests, which is usually something like:
Y and Z are unlikely because he lacks (certain other traits or symptoms)
I can rule out X with a quick check, like a 2-minute neurological exam.
3) Think horses, not zebras.
Good question, To make a list of criteria for what is “reasonable threshold” for each disease, given each symptom, and each test, such a thing would probably be more trouble than it’s worth for the simple in-the-room tests, but I’m sure they exist for expensive/harmful things like biopsies or CT scans. In this case, I think the presentation exceeds the threshold to consider a stroke, but not enough to do costly tests.
In general, we’re drilled with the general algorithm: 1) a long list of “triggers” that says, “if you see this/these symptom(s), you should immediately put dangerous diseases X, Y, and Z on your differential.” e.g. disorientation and slurred speech, the word “stroke” should AT LEAST enter your mind temporarily. 2) Then, rule-out X Y and Z with cheap and easy tests, which is usually something like: Y and Z are unlikely because he lacks (certain other traits or symptoms) I can rule out X with a quick check, like a 2-minute neurological exam. 3) Think horses, not zebras.