Problem Representation
A Problem Representation is a succinct, processed summary of a patient’s story, that aids in building a differential diagnosis.
It starts during the patient encounter as an internal, mental model for the patient’s main problem, and is refined throughout the encounter. It guides history-taking and the physical exam by defining the problem & sparking ideas about the differential or possible categories of disease. It helps identify important questions to ask or exam manoeuvres to do.
When we sit down to write our note or give an oral presentation, we use the problem representation we’ve built in our minds as a starting point to craft the sentence that starts the initial 'one liner' summary statement, and this is the final problem representation.
The problem representation is linked to the presenting complaint statement. The key differences are that the presenting complaint is much shorter, and it doesn't have details about the exam or test results, and is only focused on briefly describing the presenting symptom.
| Includes | Excludes |
|---|---|
| Who: Relevant Epidemiology/Risk Factors for disease | Non-specific information. Fatigue rarely helps to narrow our differential diagnosis |
| What: Key/differentiating features of the clinical syndrome (signs/symptoms) | Irrelevant information. A patient’s inguinal hernia is likely irrelevant to their neck pain |
| When: Time course/pattern/tempo (acute/progressive) |
The problem representation allows experienced clinicians to use pattern recognition to quickly develop a differential diagnosis. It allows learners to develop their reasoning skills - e.g. what is most relevant to a given clinical problem? How do we specifically define a clinical problem in order to begin to solve it?
