Okay, that puts an interesting slant on it. Case studies usually
force physicians in training to pursue one or more of four clinical
questions: a) diagnosis b) therapy c) risk factor modification d)
prognosis. The approach to each of these are lectures in an of
themselves but I will chat about diagnosis. In my opinion,
there are 6 ways to pursue a diagnosis: a) statistical - what's
most common in this epidemiological setting?, b) anatomical -
what is the range of organs that rise to the problem
(symptom/sign/abnormal lab or di finding) c) pathological - is
the problem nutritional, metabolic, degerative, neoplastic,
ischemic, inflammatory, endocrinological, infectious, iatrogenic,
toxic, traumatic, psychological? d) physiological - good for
considering the diagnosis of jaundice for example, e) pattern
recognition - what comes to mind immediately? and f) no method.
The usual approach for the beginner is consider one or more
abnormalities and using a Boolean approach make a list of common
associations using one or more of the diagnostic methods. Once a
list of possibilities is made, other facts are considered that
help to rule in or rule out the diagnostic possibilities.
There's no good way to tease out what is really important and
what is less important early in training. That is a matter of
experience.
Well, that's my approach. I suspect there is no science to
support it.
Good luck.
JPS, MD.