Differential Diagnosis: “rara avis” in medical practice

Differential Diagnosis is  a key step in Medicine, but it is poorly practiced by young and old doctors. Some of the “reasons” that especially young doctors and residents expose to justify this fact are the following:

A question of detail


1) “In the emergency room, I do not have time to make a differential diagnosis”. Although it is understood that there is a need to act quickly and effectively in the Emergency Room, this fact does not justify to elaborate a list summarizing the patient’s problem.. This is a duty for doctors  and a right of the patient and is basic for a correct  medical performance. 2) Symptoms and signs are detailed as a clinical judgment. It is difficult to explain to residents  that “hematuria” or “abdominal pain” is not a clinical judgment. It’s an easy way out to solve a step without actually doing it properly. Some medical specialties are more prone to practice this modality. 3) “Why make a differential diagnosis if it is clear, cough and expectoration can only be pneumonia.” This attitude is characteristic of older physicians who do not want to “waste time” and rely on the Type 1 reasoning process.  Sooner or later this attitude will lead to error, if we think about atypical presentations or exceptions to a rule. Is this a particular situation of a country or a society? We believe that this is a common situation in medical practice nowadays. We have to recover the Differential Diagnosis.