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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / McDonald, Kathryn / Singh, Hardeep

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Newman-Toker, David / Singhal, Geeta / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura

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The approach to a diagnostic dilemma

Daniel Lichtstein / Gauri Agarwal
  • Corresponding author
  • University of Miami Miller School of Medicine, Boca Raton, FL, USA, Tel.: +5616546614
  • University of Miami – Medicine, 2500 North Military Trail, Suite 260, Boca Raton, FL 33431, USA
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Published Online: 2018-08-21 | DOI: https://doi.org/10.1515/dx-2018-0026


Diagnostic dilemmas refer to situations in which physicians face a challenging clinical scenario. The goal of our paper is to outline strategies which we have found to be most helpful in the approach to a diagnostic dilemma. We review each strategy and provide illustrative clinical examples. Among the most helpful strategies are performing a thorough history and physical examination (H&P) (including pertinent epidemiological factors and careful medication review), avoidance of non-specific testing and empiric treatment, judicious use of consultants, maintaining an open-mind and humility and ongoing, open communication with your patient.

Keywords: diagnostic dilemma; diagnostic error; diagnostic strategies; history and physical examination


About the article

Corresponding author: Gauri Agarwal, MD, FACP, University of Miami – Medicine, 2500 North Military Trail, Suite 260, Boca Raton, FL 33431, USA

Received: 2018-05-29

Accepted: 2018-07-12

Published Online: 2018-08-21

Published in Print: 2018-09-25

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Diagnosis, Volume 5, Issue 3, Pages 127–134, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0026.

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