Physical Assessment and Clinical Decision Making Skills for a patient presenting with Appendicitis
Learning outcomes for case study:
Obtains an accurate, comprehensive, and focused health history including systems enquiry.
Integrates knowledge of the underlying anatomy, physiology, and psychophysiology concepts to interpret the significance and implications of health history and clinical examination findings to develop justifiable differential diagnoses/management plans.
Formulates justifiable differential diagnoses and the delineation of a working diagnosis, options of treatment and/or referral.
Critically evaluates contemporary policy, guidelines and evidence-based literature which inform the consultation and clinical decision-making process.
Demonstrates ability to complete accurate, comprehensive, and legally robust records of health history and clinical examination.
Critically reflects upon personal limitations in competence, knowledge and scope of practice when faced with complex clinical presentations.
Examples:
How do these findings inform your diagnosis/differential diagnoses e.g., how reliable is Psoas sign in determining appendicitis, how would you differentiate a simple chest infection from a pulmonary embolism?
Interrogate the evidence base for the employment of many of the examination skills we use. Analyse and evaluate the relevant tools, guidelines and policies which may exist around a condition that you explore i.e., how useful is the FAST test if you are faced with a potential cerebellar stroke?
How useful is the CRB65 score for community acquired pneumonia, what is the value of the Wells score for PE/DVT? –Discuss what informed your clinical decision making and how you arrived at your management plan -justify it based upon contemporary evidence contained within guidelines and policies.
Discuss any legal, ethical, and professional issues pertaining to patient assessment and to the changing/blurring of role boundaries between and within different health care professions.
Reflect upon what the shortfalls were in your assessment and be honest about your personal limitations from a perspective of your knowledge and experience in carrying out many of the examination techniques, did this influence your decision making?