I spoke to a candidate who had failed the MRCP PACES at his last attempt. We discussed presentation of findings to the examiners and in particular how to present one’s diagnosis.
I asked him how he had presented the diagnosis of the cases he had seen at the examination and the information he gave me was inadequate. He gave basic information but left out very important facts concerning function of the system concerned and aetiology.
This led us to discuss diagnosis in detail.
I realised that this candidate had not analysed what is meant by diagnosis and had not studied this in depth.
When coming to a diagnosis it is important to make this as complete as possible and find out about the organ or system concerned, the pathology affecting the organ or system, the aetiology of the illness and the function of the organ or system
In other words it is important to elucidate the four components of a diagnosis:
Anatomical diagnosis (where is the lesion)
Pathological diagnosis (what is the pathological process)
Aetiological diagnosis (what is the cause of the lesion)
Physiological diagnosis (what is the function of the organ or system concerned)
If one presents one’s diagnosis in this manner it will demonstrate to the examiner that one is thinking clearly and this is likely to influence the marks obtained.
For an analysis of diagnosis, the four components of diagnosis and checklists for use in situations where it is difficult to come to a diagnosis; see chapter 3 of ACES for PACES
This is a blog about clinical skills or bedside skills. That is the skills needed for a successful doctor patient relationship. The skills are history taking skills, physical examination skills and communication skills. The discussion on this blog is based on the book: ACES for PACES advanced clinical evaluation system for practical assessment of clinical examination skills by ajith jayasekera