Chief Complaint: A Focused Stem

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Identifier chief_complaint_a_focused_stem
Title Chief Complaint: A Focused Stem
Subject History; Complaint; Diagnosis
Creator Andrew G. Lee, MD, Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, TX, Professor of Ophthalmology, Weill Cornell Medicine; Nicole Alexander, Baylor College of Medicine, Class of 2021
Description Summary: • Presenting a chief complaint as quotation marks in a patient's words may not be the best and most efficient method. • A focused chief complaint should include: o Age o Gender o Timeframe (acute, subacute, chronic) o Painful or painless o Clinical sign • Example: Optic neuritis o 20-year-old white female presents with acute, unilateral loss of vision, pain with eye movement, a relative afferent pupillary defect, and a normal fundus. • This method allows formation of a fast differential diagnosis and focused exam.
Transcript Today, we are here to talk to Dr. Lee about the chief complaint in neuro-ophthalmology. In medical school, we are taught to put the chief complaint in the patient's words. Often, it's in ‘quotation marks'; for example, ‘I have eye pain'. Dr. Lee, what do you think about this method for chief complaints?" "Even though I think that there is some rationale and reason for doing it that way, in the very busy clinic, I prefer to have a focused stem. By a focused stem, I mean having their age, their gender, the tempo of whatever happened to them in terms of acute, subacute, or chronic, whether it was painless or painful, and then the clinical sign. So, for example, a 20-year-old white female presents with acute, unilateral loss of vision, pain with eye movement, a relative afferent pupillary defect, and a normal fundus. That's the stem for optic neuritis. And we can get to optic neuritis very quickly with a focused chief complaint that incorporates all the features that I just told you. However, if we were to change the stem to say an 80-year-old white female with acute unilateral loss of vision, headache, pain in their jaw, a relative afferent pupillary defect, and a normal fundus - that subtle change in the stem creates a different differential diagnosis, and leads us towards giant cell arteritis rather than optic neuritis. It is that kind of change in terms of the chief complaint that I think is much more valuable to learners, including medical students, than just putting in ‘quotation marks' their chief complaint. Especially if it is a vague complaint like blurred vision or double vision. Blurred vision can mean cataract, it could mean pituitary apoplexy, it could mean you're going to die in the next 30 minutes. There is no way for us to know from that unfocused stem where we should be focusing our energies and what we should be doing on exam. So, to me, the best chief complaint is a focused stem that allows the listener to already be in the formulated differential diagnosis from the start, and ideally is sufficiently focused to be able to get to the diagnosis or at least the top of the differential diagnosis very quickly. So that's kind of my take on the chief complaint.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2019-10
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6b900ms
Setname ehsl_novel_lee
Date Created 2019-10-10
Date Modified 2020-01-27
ID 1469289
Reference URL https://collections.lib.utah.edu/ark:/87278/s6b900ms
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