Since day 1 of veterinary school, we have been taught to address any clinical problem with a systematic approach. For every case, we ask the history, come up with a problem list, figure out a differential list of potential causes, and then pursue diagnostics and finally perform treatment once a diagnosis is made. The more cases that I’ve seen, the more aware that I am of the importance of a systematic approach. Experienced practitioners may readily recognize the pattern of a specific disease and then make the diagnosis. However, it can be dangerous to have tunnel vision and not assess every aspect of the clinical picture, especially for beginners.
The usefulness and importance of a systematic approach again became obvious to me during my recent radiology rotation. At first, when we were given the patient’s history, we tended to focus on the specific organ system that was suspected of having the disease. At times we even made up things in order to make the radiographic findings fit whatever disease we suspected. Such bias is a huge barrier to complete and correct interpretation of radiographs. If we were not given a patient’s history, we may have shown less bias. However, it’s unlikely that we’ll know nothing about the patient’s history when we read radiographs in daily practice. A systematic approach helps us assess the case in a clear and thorough manner. For example, when interpreting an abdominal radiograph, we start with the musculoskeletal structures, then the chest that’s included in the view, and then the abdomen. Surprisingly but not uncommonly, we recognized pathology in the bones or in the lungs when reading abdominal radiographs.
I find it really helpful to follow a systematic approach when dealing with clinical problems. Not only does it help me to assess the whole clinical picture, but it also calms me down when I have no idea what’s going on at first. I know there must be a way to figure it out, and I just need to follow the path.