Action Planning

Options for diagnosis
Likelihood
Most likely, most serious

When planning the next actions after taking a history and examination it helps to consider the following.

Options for diagnosis

What are the possible causes for the problem? Think widely and use a sieve eg infection, tumour, trauma, iatrogenic, degenerative. Have your own sieve that you remember, use a pneumonic if need

Likelihood

What is the probability of each being the cause of the presenting problem. There is no need to be exact but roughly to help guide your thinking. A figure 80:20 if you prefer, but it is often easier to say very likely, quite likely or unlikely.

Most likely, most serious

Now stand back, look from afar and pick out the most likely and most serious overall. There may be one or two in either category.
Base your initial proposed action plan on these. You can be build on from this at the next appointment. Indeed, at review, things often become much clearer anyway.
In the action plan you are tackling the most likely and excluding the most serious.
Of course if the most serious is also the most likely then act on it immediately.
And don’t forget to share your proposed action plan with the patient as options. This is so that they are involved and have an opportunity to include their viewpoint and expressed preferences. Often patients will have insights or suggestions which improve the plan. After all, they have lived with the problem for longer than you have had time to consider it
Action Planning