The Patient Consultation

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PatientConsultIdentify likely organ affected and disease process
  • Establish the possible anatomical region or organ system suggested by the presenting complaint
  • Evaluate the presenting complaint in detail (follow any of the common methods)
  • Enquire about all other symptoms related to the implicated organ system e.g. PC – dysuria   ROS – frequency, hesitancy, haemturia, poor stream, double micuturition
  • Enquire about pre-existing disease that are likely to be related to the cause of the symptoms e.g. heart and respiratory disease for dyspnea; digestive, urinary tract, hepatic disease for abdominal pain (use broad categories if unsure about specific diseases)
  • Perform a systematic examination of the anatomical region or organ system implicated
  • Identify the behavioural triggers that precipitate acute episodes which may give a clue to the pathology or organ involved
  • Identify generic symptoms identifying the pathological process
  • Screen for  an underlying cause, risk factor or medical problem for disease

Doing this should give you some clue about the underlying pathological process, which organ system is involved and the likely set of investigations you should complete

Multiple seemingly unrelated symptoms are due to chronic inflammation/infection, toxin, endocrinological or psychological (in kids it will be a congenital syndrome or metabolic disorder)

Determine severity

  • Are the symptoms affecting the patient’s life?
  • Have the symptoms recently increased in severity, frequency or persistence?
  • Are the symptoms affecting organ function e.g. CVS – syncope, hypotension, Resp – dyspnoea, GIT – weight loss, Neuro – altered consciousness/speech/behaviour, limb weakness/incoordination

This will determine how urgently you wish to begin costly investigation or risky treatment.  It also affects acute prognosis but chronic prognosis is dependent on how quickly these resolve with treatment.

Acute worsening of symptoms are generally caused by a small number of things

Generate a differential diagnosis based on suspected organ involved and pathological process

  • Review additional causes for the pathology or potential consequences/complication
  • Verify your differential by mapping the historical course of the patient’s complaints with the likely sequence of cause, disease, complications and manifestation
Consider a watch and wait and policy or commence investigation
  • Determine if course and severity warrant further evaluation or treatment

Commence an Investigation strategy

Treat the underlying pathological process

  • Other treatments reverse the specific pathophysiology e.g. brochospasm > bronchodilator, upper GI acid production > antacids, decreased gastric motility > laxatives

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