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Journey of a DPT Student

Differential Diagnosis

Published October 10, 2011 3:02 PM by Lauren Rosso

With our first true musculoskeletal practical just two days away, we're finally getting into basics of differential diagnosis. As our focus is currently at the hip joint with some potential low-back influences, I originally thought there wouldn't be much to differentiate between. However, as the weeks have gone on and we've learned more and more about symptom presentation, I couldn't have been more wrong. So many things present so similarly!

I imagine this is a skill that develops with time, and that we'll easily be able to rule out certain pathologies simply based on the patient's history. But for now, I find myself fumbling with diagnoses that I should be able to recognize, second-guessing myself and then forgetting the most basic characteristics. I just get lost in the middle of everything, and I find it very difficult to remove myself from the immediate panic and recognize the obvious signs and symptoms that are being presented.

I also haven't had to perform any sort of differential diagnosis in a true patient setting. Some classmates have had the opportunity to work through an initial evaluation at their clinical sites and apply some of the principles that we're learning in class. As nervous as I know I would be, I think it could be really helpful to be forced to use these tests and diagnostic tools in a real setting. If nothing else, it would make the practical feel like a very controlled, safe environment.


Jeni- it sounds like you're on the right path!  From what I've seen in these first few months, identifying the limitations/impairments is the most important.  Realistically, that's what we treat!  For me, it made a lot more sense once I got into the clinic.  Seeing these impairments on an actual patient is so much more helpful.

Good luck!  Sounds like you're doing great, anyway.  

Lauren Rosso January 12, 2012 7:47 PM

Thank you for your post about this. I have a hard time providing a solid diagnosis as well. I can identify the patient's impairments, functional limitations, and disabilities and formulate ideas for goals (we have not yet started developing treatment plans, so only rough time estimates), but I have a very difficult time applying a name to the condition. I am hopeful that as we do more evaluations, both in the practical setting with our classmates and professors and in the clinic, which we will be able to better distinguish between conditions. In our program, we do not have very much clinical time (3-4 shadowing sessions with professors and PTs in the ECU hospital and PT clinic) prior to the first clinical in the spring of our first year, so all evaluations we have completed to this point are on our students. While this is helpful to learn the various exam procedures and tests, I think that it will help me to be with a patient with more visible symptoms (such as an irregular gait pattern or swelling, etc.) rather than have a professor describing what we see.

Jeni Duckett, DPT - Student, ECU January 9, 2012 9:43 PM
Greenville NC

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