You’ve ordered a slew of tests for your patient. You
hope that one of them comes back positive, giving you guidance for the next
step in the patient's care. However, your tests all come back negative, leaving
you wondering what to do next.
This is a common scenario whether you work inpatient,
outpatient, or a combination of both.
Most of the time, it’s easy to know what to do if the
tests are positive. It’s much harder to decide what to do if the tests are
negative.
We cannot discuss every single scenario, but it’s
important to bring up the following concept:
When you order
a test, consider what you will do if the result is negative.
Do this and you find yourself one step ahead in many
clinical scenarios.
Ask yourself questions like:
·
Should I expand my differential diagnosis?
o If
so, what other diagnoses should I check for?
o If
not, am I sure that I have enough information to proceed with treatment?
·
If I need more information, how will I get it?
o More
tests? more History? More physical exams?
Experienced physicians often get to the point that they
internalize these processes. However, even experienced physicians can still get
stuck when they unexpectedly get negative test results. To be more ready to
adapt to these situations, it is good practice for all physicians, from brand
new to well-seasoned, to explicitly ask themselves
what their next step will be if the tests they order are negative.
Clinical practice is a tricky thing, and events do not
follow the textbooks and guidelines. If you think a step ahead and plan out the
next steps for when your tests are negative, you will be more ready when your
tests results are unexpectedly negative.
If you are interested in learning more about this and
other topics in clinical decision making, check out my book A
Guide to Clinical Decision Making.
