Self Diagnosis
Older people have lived a long time and may have had a lot of previous health problems. They may arrive in ED, convinced that they have a specific problem, “just like the last time”.
Important Note
Anchoring on a previous diagnosis or premature closure are dangerous cognitive errors in ALL patients. But especially in older ones!
Because older patients present atypically, we must consider their condition carefully. Keep an open mind:
- the nausea associated with the current MI may feel like nausea of the previous ulcer;
- the flank pain of the current leaking AAA may feel the same as the previous ureteral stone;
- The unilateral headache of the current spontaneous subdural hematoma may feel similar to the hemicranial pain of the previous migraines!;
- The mild confusion of the current pneumonia may look to the family the same as the last time Mom had a UTI
Discussion: Self Diagnosis
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Bons trucs
Diagnósticos diferenciales y siempre abordar al paciente de cero
collateral hx
always generate a complete ddx in the elderly even with vague symptoms
Agreed. Younger patients are usually right about symptoms that are similar to previous medical issues, but older patients are often wrong.
ok
sad
acknowledge their autonomy but thoroughly investigate other things
so true
great tips
true
ok
all good points
good to know
avoid anchoring – good point
cool
good point
nice
….
makes sense
.
yes
conduct a thorough examination
cool
HYEAH
ok
avoid tunnel vision and explore all avenues.
good point
none
good point
Diagnoses are challenging in the elderly! It’s good to know the differentials to help narrow down the possibilities of vague complaints
yes, Indeed
true
–
–
oi
yes
great point
J
very helpful information.
good case
agreed
me too
great case
..
ok
ok
.
.
Agreed that is why no one should leave without blood work
yes
yes
ok
–
why do we have to comment on everything
You don’t
It is annoying.
I don’t comment on everything and I still pass and get my certificate.
It’s pointless saying ‘yes’ or ‘OK’ every time.
Nice points
How true
yes
geriatric patients do tend to relate present symptoms with past experiences to give meaning and explanation to what is happening.
Googleized
workup completely
Right
ok
good to know
k
k
agree
true
it is true, the culture and background of the elderly patient may influence them to assume a diagnosis which was previously given or experienced by a friend or family. a detailed history and physical examination is always important
also alot of of the elderly believe strongly in traditional medicine and diagnoses
Agreed
good point
yes
Good point to be cautious to not anchor on a diagnosis when the patient says it’s the same pain or presentation as in the past.
.
good lesson
En nuestro medio es muy usual el autodiagnostico en los adultos
ok
never make assumptions
premature closure or anchoring bias
very true
good tips
true
Very true.
good point
nice
good points
very good point. it is easy to compare to previous results. all causes must be examined.
Important to understand that not all patients are the same
will remember this for my clinical practice.
good point
Beware the garden path…
stay broad
excellent advice
good points
so ture
good points here
Good
good point
Every patient and every presentation to the ER is a clean slate!
good point.
ok
it is important to gather all important information to have a complete health history to have a correct diagnosis
not good
Do not assume anything
Good point.
Keeping an open mind is crucial. The internet has also made things more complicated. Our seniors are getting computer savvy and are looking up conditions with signs and symptoms.
good review
Need to remember each pt is a clean slate
a great reminder and very true
I think we need to correlate with DD of the problems if an elderly person try to do self diagnosis.
good to remember
very helpful
extremely important point
Good point.
Excellent example
don’t let your guard down, the one time you rely on previous diagnosis is usually when you are wrong
Anchoring on a previous diagnosis or premature closure are dangerous cognitive errors in ALL patients. But especially in older ones!
good review
anchor bias will get you every time
advice noted
great tips
importante para el futuro
consejos para tomar encuenta
muy importante
muy buenos tips
Good tips
Always take a full history. Although we take into consideration the patients or family’s opinion we need to consider all the possible differentials.
Do not make assumptions.
Keep an open mind always and exclude all serious and common illness before arriving at a particular diagnosis
self
xxx
lll
Every presentation is a different new case,start from A to Z and make a broad imagination with each case.
I frequently ask patients to relate this symptom to one they have previously. Seems like a risky tactic in the elderly
Excellent point, same presentation but difference causes
good pt
an instance where asking “have you ever felt like this before” can be very misleading…..
Good point. It can be tempting to look for an easy or simple explanation for the presentation in the ER.
Agreed. As physicians we must be mindful to not piggy-back on previous diagnoses