Dr. Stein’s Problem-Based Learning “I Can’t Walk Because of Fever and Physical Pain!”

抄録

In this article, I introduce one of the lectures of Dr. Gerald Stein (courtesy clinical assistant professor, Department of Medicine, University of Florida, USA) on problem-based thinking processes.

The patient was an 85-year-old woman who presented complaining of fever, cervical pain, headache, and shoulder pain. First, a problem list was prepared based on a careful patient interview. Next, differentiation was performed for “diseases that must not be overlooked.” It is most important to avoid jumping suddenly into a plan. Identifying the relationships between all three categories of problem list, differential diagnosis, and plan is necessary. The entire problem list is related to differential diagnoses, and all differential diagnoses are linked to the plan. Conversely, all plans should traceable back to identified problems.

Particularly in cases where a variety of symptoms are present, a thought process such as shown in this lecture is very important to reduce missed diagnoses and eliminate unnecessary tests.