Page 9 - Problem-Based Feline Medicine

1. How to make a problem-based

diagnosis

Jacquie Rand

● Competence at making a diagnosis is the most important part of being a
veterinarian. Therefore, it is the most important skill learnt in veterinary
education. High-level surgery skills and in-depth knowledge of drugs may be
useless if the wrong diagnosis is made.
● Making a diagnosis involves problem-solving. If clinical signs are treated
without first making a diagnosis, it is likely that corticosteroids, antibiotics and
euthanasia will be over-prescribed.

There are two ways to make a diagnosis. Firstly 1. Obtain detailed data from a complete history and
there is the “expert method”. This is the way physical examination.
many veterinarians make a diagnosis, and it Take an exact and detailed history. It is critical
involves pattern recognition. that questions are asked to cover a detailed
The disadvantages of the “expert method” are that it history in all areas of the pet’s health, not just
requires a lot of experience to be accurate, and there is for the problem presented. To get the correct
a greater chance of being wrong, especially for the less- information it may be necessary to ask the
experienced practitioner, because the same signs may same question in different ways.
occur for many diseases. For example, diarrhea may be
Complete a thorough physical examination.
caused by many diseases including intestinal parasites,
food intolerance, intussusception, lymphoma and The history and physical examination are the most
inflammatory bowel disease. The appropriate treatment critical parts of making a diagnosis.
varies depending on the diagnosis. Diagnostic tests may not overcome deficiencies in
the history and physical examination. For example, if
The second method of making a diagnosis is by hematology and biochemistry analyses were performed
using a problem-based approach. This leads to but a chest radiograph was not taken because increased
fewer mistakes and facilitates better veterinary frequency of coughing was missed in the history, or
practice. dyspnea was missed on the physical examination, a pri-
mary lung tumor may be missed despite performing
many other tests to determine the cause of lethargy.
KEY ELEMENTS FOR MAKING ● Normal physical examination findings need to be
A PROBLEM-BASED DIAGNOSIS appreciated before abnormal findings can be identi-
fied. Veterinary students are encouraged to take
To make a problem-based diagnosis, the signs exhibit-
every opportunity to practice physical examinations
ed are separated out into individual problems, and each
so the range of normal is recognized.
problem is considered separately.
The individual steps in making a problem-based 2. List the problems identified based on the history
diagnosis are as follows. and physical examination.
1