A third type of workup has been added to the software: a Review of Systems that covers many different body systems. In the figure below, pertinent positive and pertinent negative findings have been entered for an 85-year-old man (subscribers can click here to load these findings):
The differential diagnosis (accessible through the Dx button on the top black navigation bar) is dominated by hypovolemic syncope and digitalis toxicity. The green bars that denote the “usefulness” metric in the software highlight the bundle of findings of vital signs. The bundle includes the orthostatic decrease in blood pressure seen in hypovolemic syncope and the bradycardia seen in digitalis toxicity. Entering that the patient has bradycardia pushes the diagnosis to digitalis toxicity.
Starting the assessment of a patient using the review of systems can be a very efficient way to reach the diagnosis. In other cases it can be more helpful to begin with one of the other 2 workup types: for particular problems or specialties.