Also, is there some sort of reasonable threshold? It’s not as though strokes are extremely rare, though they are rare compared to getting drunk on Friday night.
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.
Also, is there some sort of reasonable threshold? It’s not as though strokes are extremely rare, though they are rare compared to getting drunk on Friday night.
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.