Illness Scripts: Difference between revisions

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An illness script is a structured mental summary of a doctor's knowledge about a specific disease. It represents a their knowledge about a particular disease, and may be as short as a paragraph for a rare disease, or as long as a book chapter for a commonly encountered illness. Classically, the components of a thorough illness script fall into three main categories:

Risk factors for the disease
Pathophysiology
Clinical characteristics.

Within these categories, illness scripts often include a disease's pathophysiology, epidemiology, time course, salient symptoms and signs, diagnostics, and treatment. For example, a provider’s illness script for lateral femoral cutaneous nerve entrapment (LFCNE) may include:

Illness Script Example: Lateral Femoral Cutaneous Nerve Entrapment
Pathophysiology	Entrapment of the lateral femoral cutaneous nerve
Epidemiology	3.4–4.3/10,000 person-years It is significantly linked to carpal tunnel syndrome, pregnancy, obesity, and diabetes mellitus
Time course	Chronic
Salient Symptoms and Signs	Pain and/or dysaesthesia, and sensory changes without motor findings, in the distribution of the lateral femoral cutaneous nerve.
Diagnostics	Usually clinical diagnosis. Diagnostic injection and MRI can corroborate the diagnosis.
Treatment	Conservative management, injection, hydro-dissection.

With experience, providers hone their illness scripts in three important ways:

They encode a predictive value for each feature of the disease, enabling them to estimate the likelihood of a diagnosis when that feature is present or absent. Example: The absence of a pain does not exclude the diagnosis of LFCNE.
They emphasize distinguishing characteristics whose presence or absence significantly alters the likelihood of the diagnosis, and helps differentiate it from another related diagnosis. Example: symptoms occurring in a well circumscribed area in the distribution of the lateral femoral cutaneous nerve highly suggestive of LFCNE and makes lumbar radicular pain causes less likely.
They develop a list of disease mimickers to consider when an illness script of a particular diagnosis is invoked. Example: L2 or L3 radiculopathy, pelvic mass, superior gluteal nerve entrapment, hip joint pain, inguinal hernia, GTPS, femoral neuropathy.

This iterative process continued throughout a clinician’s career, adds depth, precision and differentiating power to the foundational scripts developed during training. Diseases encountered less frequently will have less robust scripts.

The key to diagnosis lies in appropriately selecting which details to commit to memory.

“The skillful workman is very careful indeed as to what he takes into his brain-attic”
—Sherlock Holmes, A Study in Scarlet

Articles

References

Part or all of this article or section is derived from Illness Scripts Overview by JGIM, used under CC-BY-NC-SA

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- An illness script is an organized mental summary of a provider’s knowledge of a disease (1-3). It represents a clinician's knowledge about a particular disease, and may be as short as a 3x5 pocket card description for a rare disease, or as long as a book chapter for a commonly encountered illness. Classically, the components of a thorough illness script fall into three main categories: “the predisposing conditions, the pathophysiological insult, and the clinical consequences (4).” Within these categories, illness scripts often include a disease's pathophysiology, epidemiology, time course, salient symptoms and signs, diagnostics, and treatment. For example, a provider’s illness script for community acquired pneumonia (CAP) may include:
+{{partial}}
+An illness script is a structured mental summary of a doctor's knowledge about a specific disease. It represents a their knowledge about a particular disease, and may be as short as a paragraph for a rare disease, or as long as a book chapter for a commonly encountered illness. Classically, the components of a thorough illness script fall into three main categories:
+* Risk factors for the disease
+* Pathophysiology
+* Clinical characteristics.
-Synonym	Meralgia Paraesthetica, Bernhardt-Roth syndrome
+Within these categories, illness scripts often include a disease's pathophysiology, epidemiology, time course, salient symptoms and signs, diagnostics, and treatment. For example, a provider’s illness script for [[Lateral Femoral Cutaneous Nerve Entrapment|lateral femoral cutaneous nerve entrapment]] (LFCNE) may include:
-Epidemiology	3.4–4.3/10,000 person-years
+{| class="wikitable"
-Risk Factors	Obesity, diabetes, pregnancy.
+|+Illness Script Example: Lateral Femoral Cutaneous Nerve Entrapment
-History	Pain and/or dysaesthesia
+!Pathophysiology
-Examination	Sensory changes without motor findings.
+|Entrapment of the lateral femoral cutaneous nerve
-Diagnosis	Usually clinical
+|-
-Tests	Diagnostic injection, MRI.
+!Epidemiology
-DDX	L2 or L3 radiculopathy, pelvic mass, superior gluteal nerve entrapment, hip joint pain, inguinal hernia, GTPS, femoral neuropathy.
+|3.4–4.3/10,000 person-years
-Treatment	Conservative management, injection.
+It is significantly linked to carpal tunnel syndrome, pregnancy, obesity, and diabetes mellitus
+|-
+!Time course
+|Chronic
+|-
+!Salient Symptoms
+and Signs
+|Pain and/or dysaesthesia, and sensory changes without motor findings, in the distribution of the lateral femoral cutaneous nerve.
+|-
+!Diagnostics
+|Usually clinical diagnosis. Diagnostic injection and MRI can corroborate the diagnosis.
+|-
+!Treatment
+|Conservative management, injection, hydro-dissection.
+|}
+With experience, providers hone their illness scripts in three important ways:
-With experience, providers hone their illness scripts in three important ways (5):
+# They encode a predictive value for each feature of the disease, enabling them to estimate the likelihood of a [[diagnosis]] when that feature is present or absent. Example: The absence of a pain does not exclude the diagnosis of LFCNE.
+# They emphasize distinguishing characteristics whose presence or absence significantly alters the likelihood of the [[diagnosis]], and helps differentiate it from another related diagnosis. Example: symptoms occurring in a well circumscribed area in the distribution of the lateral femoral cutaneous nerve highly suggestive of LFCNE and makes [[Lumbar Radicular Pain and Radiculopathy|lumbar radicular pain]] causes less likely.
+# They develop a list of disease mimickers to consider when an illness script of a particular diagnosis is invoked. Example: L2 or L3 radiculopathy, pelvic mass, [[Superior Gluteal Nerve Entrapment|superior gluteal nerve entrapment]], [[Hip Pain Differential Diagnosis|hip joint pain]], inguinal hernia, [[Gluteal Tendinopathy|GTPS]], femoral neuropathy.
-They encode a predictive value for each feature of the disease, enabling them to estimate the likelihood of a diagnosis when that feature is present or absent. Example: The absence of a fever does not exclude the diagnosis of community acquired pneumonia (CAP) in an elderly patient.
+This iterative process continued throughout a clinician’s career, adds depth, precision and differentiating power to the foundational scripts developed during training. Diseases encountered less frequently will have less robust scripts.
-They emphasize distinguishing characteristics whose presence or absence significantly alters the likelihood of the diagnosis, and helps differentiate it from another related diagnosis. Example: A lobar infiltrate on chest x-ray without cardiomegaly or cephalization of vessels is highly suggestive of CAP and makes congestive heart failure less likely.
-They develop a list of disease mimickers to consider when an illness script of a particular diagnosis is invoked.Example: Chronic obstructive pulmonary disease (COPD) exacerbation and congestive heart failure resemble CAP
+The key to diagnosis lies in appropriately selecting which details to commit to memory.
-This iterative process continued throughout a clinician’s career, adds depth, precision and differentiating power to the foundational scripts developed during training (5). Diseases encountered less frequently will have less robust scripts.
+{{Quote|The skillful workman is very careful indeed as to what he takes into his brain-attic|Sherlock Holmes, A Study in Scarlet}}
 ==Articles==
-*[[:Media:charlin2007 Scripts and clinical reasoning.pdf|Scripts and clinical reasoning - Charlin 2007]]
+*[[:Media:Charlin2007 Scripts and clinical reasoning.pdf|Scripts and clinical reasoning - Charlin 2007]]
-*[[:Media:schmidt2007 How expertise develops in medicine knowledge encapsulation and illness scripts.pdf|How expertise develops in medicine: knowledge encapsulation and illness scripts - Schmidt 2007]]
+*[[:Media:Scripts and Medical Diagnostic Knowledge - Charlin 2000.pdf]]
-*[[:Media:custers2014 Thirty years of illness scripts.pdf|Thirty years of illness scripts - Custers 2014]]
+*[[:Media:Schmidt2007 How expertise develops in medicine knowledge encapsulation and illness scripts.pdf|How expertise develops in medicine: knowledge encapsulation and illness scripts - Schmidt 2007]]
-*[[Media:Cox2006 Educational Strategies to Promote Clinical Diagnostic Reasoning.pdf|Educational Strategies to Promote Clinical Diagnostic Reasoning - Cox 2006]]
+*[[:Media:Custers2014 Thirty years of illness scripts.pdf|Thirty years of illness scripts - Custers 2014]]
+*[[:Media:Cox2006 Educational Strategies to Promote Clinical Diagnostic Reasoning.pdf|Educational Strategies to Promote Clinical Diagnostic Reasoning - Cox 2006]]
+*[https://www.sgim.org/web-only/clinical-reasoning-exercises/illness-scripts-overview Illness Scripts Overview - JGIM]
+*[https://clinicalproblemsolving.com/illness-scripts/ Illness scripts in general medicine]
+== References ==
+{{Article derivation|article-link=https://www.sgim.org/web-only/clinical-reasoning-exercises/illness-scripts-overview|article=Illness Scripts Overview|author=JGIM|license-link=https://creativecommons.org/licenses/by-nc-sa/4.0/|license=CC-BY-NC-SA}}
 [[Category:Clinical Reasoning]]