Some clinical situations are common enough that there are ready-made “workups” for them. Using a workup is one of the 3 cognitive modes of starting the process of diagnosis.
In the paper textbook era, workups were conceived of as lists or flowcharts. With the availability of decision support software for diagnosis, a workup can be more sophisticated.
Workups encapsulate a lot of clinical wisdom about findings that tend to occur together. Using workups (paper or software) enables you to quickly collect a set of findings to refine the differential diagnosis.
There are workups for many specific problems such as anemia and psychosis. Some specialties such as neurology check a standard set of findings that can be formulated as a workup. The most general of workups is the Review of Systems, which surveys some common findings in a variety of body systems.
Example to work through
A 16 year old girl has recent onset of psychotic thought patterns and hallucinations. It is obvious to be concerned that this is schizophrenia, but using a workup one can get a broader differential diagnosis. One can begin by specifying the age and sex and then choosing the green W/u button that appears:
After selecting Problem workups and choosing Psychosis, one can specify that hallucinations and psychotic thought pattern are recent by clicking the component to the left of each finding. Green bars appear on the findings in the workup to suggest which other findings have highest Usefulness in reaching a diagnosis, e.g., personality change. (Click any of the images below to launch the software in the state shown).
But first, by clicking on the green “Go to Dx” button one can see the differential diagnosis so far. As expected, it focuses on schizophrenia:
Returning to the workup by clicking W/u on the top black navigation bar, one can specify that personality change is recent.
The usefulness of the remaining findings changes because addition of more information has changed the differential diagnosis on which the Usefulness metric is based. One can add one of the other useful findings, choreoathetosis:
The differential diagnosis has now changed to include conditions such as anti-NMDA receptor encephalitis and porphyria. Many young people with these conditions have been misdiagnosed as having schizophrenia.
One can then use other of the Elements of diagnosis to make further progress towards a diagnosis.
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