Precedent set diagnosis

Check the past history
Ask has it happened before?
Look at past consultations

When you see a patient consider if they have presented with similar symptoms before. Often they will have done so and somebody, occasionally yourself, will have already done the work of diagnosis. If you are lucky the management plan may have been tested out and you will be able to see what was successful.

Check the past history

Before the patient comes in it is worth looking at the problem list and seeing if are there are any indications for why they have attended this time. The receptionist or nurse may have recorded a reason. The last consultation may indicate an ongoing problem. It is also worth looking at your own last consultation so you can build on from it. Often the past history will give you clues for the presenting problem, perhaps the diagnosis or the best management plan.

Ask has it happened before?

The patient is the expert in how their own body patterns whilst the doctor is an expert in advice about the body. Working together is the most productive. Ask them if they’ve had the symptoms before? Ask what they were told it might be and what was done before? Was it successful? This may be quite recent or it may be many years earlier, but this information can make things much quicker second time round. An example is depression if the patient had it before they may present earlier. Did the last episode settle with counselling or did it need medication? How quickly did they get better may indicate if the current episode will resolve on its own or if medication would be more appropriate at an earlier stage.

Look at past consultations

Scroll back through the records to see if there were similar presentations, which the patient may have forgotten. Sometimes you can use past medications to identify this. For example a patient presenting with chest pain and past prescriptions for antacid or perhaps a nitrate. Identifying the drug history can then take you to the starting point for those prescriptions and then take you to the relevant consultation.