Keytostudy for doctors: remembering protocols

We have many medical students and doctors. There is one question we get quite often:

T.R.:

I would love to know more about how we can structure patient presentations and their differential diagnosis. In a way where you never forget anything. And then once you have the differential and more effective method for not missing any of the tests.

I am not a medical doctor, nor am I training to become one, so my experience comes from memory training, development of diagnostic equipment and my personal life.

The task of diagnosis is somewhat similar to walking the streets of a city and finding the right turns. Each crossroad is a hypothesis and houses are symptoms. From what I know, you need to analyze a lot of specific scenarios before the streets of the city become familiar. With time, you will be able to recognize specific symptoms like houses in your town and immediately understand where you stand.

Anna is teaching very similar protocol-based approach using mindmaps. You start from a simple collection of symptoms or situation, then you have 5-6 various choices you can make open as a mindmap. At each junction of the mindmap you open up new choices, until you get to the diagnosis.

Now how do you build this mindmap or city chart? You could, in theory, build it from scratch, however such task would be monumental. Instead, you build it in small sections by analyzing specific examples, and then you may hope that all the small examples will later merge into a huge superstructure. You cannot possibly expect that this merge will be seamless, and occasionally you will need to apply corrections, enforcing strong links (identity, causality or mutual exclusion) between mindmaps that were created independently. These “correction” links that come IN ADDITION to analysis of specific cases, requires more mental energy and creative thinking – the energy invested into them will eventually set you apart as being able to process complex cases which will be too hard for your peers.

Another way to formulate the same task is creating, so called “logical markers”. Some logical structures are quite common. For example, any medicine is somewhat a poison that should be avoided in certain situations. This causes a chain of (symptoms)->(medicine)->(side effects), where sideffects quite often present themselves as additional symptoms. Alternatively, we could have (chronic issues)->(degradation)->(new symptoms) chains of events. Having specific markers for these common chains of events, enables easy encoding of very complex situations.

Do not encode medical information as shapeless abstractions – try to imagine face or body to fit any situation. 200 years ago, there were masters making exact replicas of damaged organs from glass, so that medical students could understand how the relevant desease looks. You do not need to use glass, the power of your imagination and online imagery provide all the information you could usually need.

200 years ago there was little more than a dozen of diagnoses any doctor knew and could treat, anything doctors could not treat was ignored. Now each doctor should be able to diagnose hundreds of medical conditions, and the medicine is capable of treating many thousands of conditions and diseases. As such, it is no more possible to remember all protocols, and you should not feel bad searching for the information you need online. Yet, no online depository can replace a professional with acute intuition developed by years of practice. Your practical experience is quite unique. Take a good care of it, adding new information to your mindmaps. Make notes and review what you remember from time to time to take care of your treasure.

Knowledge is power and responsibility. Some knowledge is a protocol of “know what” happened, and some is a protocol of “know how” to act upon it. Both types of knowledge are equally important.