Sometimes it feels like my weakest quality in medicine is building my differential diagnosis. I get stuck in the rare diseases (even though we actually do see a lot of those here) and forget about more common or abstract conditions.
To combat this, I have started a new Saturday morning task. I call it "My NEJM Case Report DDX."
As a medical student, you can get the NEJM in Print+ipad+online for around $70 per year. I got a super special deal and got a water bottle and duffle bag with my $59 sale purchase. DEFINITELY WORTH IT. I love getting my print copies in the mail. I take them to appointments where I know I will have to wait a while and get in a quick read. Even studying for Step 1, I though the review articles were really well done and relevant in my studying when I wanted something fun and to change up my routine.
So how does the Case Report DDX work? In each issue of NEJM there are clinical vignettes and high-yield clinical images. Each week I take a different vignette and work through it.
I then compare my differential to that of NEJM's to see if my rationale was correct in choosing the diagnosis and to see which ones I missed!!!! The ones I miss are critical. I mark these with a red star to follow-up with afterwards to refresh my brain on these diagnoses. I question myself: How could I have made this connection? Was it a knowledge gap or did I just not think of it?! Brushing up on these topics is important and especially making sure you have the symptoms and common presentation down!
Finally, I focus on the explanation of the final diagnosis and the treatment plan. I reassess my differential. Based on the knowledge I have of the final dx, was I heading in the right direction? What key elements in the case that they provided would have led me down the correct path? The symptoms or diagnoses I miss are also great topics for a future mind-map (an up and coming blog post). Making these connections in your mind is what is going to give you access to them later in the real patient setting.
The NEJM Case Report DDX only takes about 15-20 minutes to complete and is really fun! Making new connections, learning from imaging, and having a case laid out for you in completion is really 1) handy 2) easy to learn from 3) time efficient.
Do you do something similar to this or have your own ddx method? Do you have another reference for good case reports online? I'd love to hear about it in the comments or via email!!
M3 at Mayo Clinic School of Medicine