My case
Luca is a of 70 years old retired chef, with a diagnosis of type 2 diabetes. He lives alone. Luca present complaint is hyperglycemia (high blood sugar) between 12-24mmol/l. Luca gained 2 stones weight in the last few months .
Luca was prescribed 500 mg Metformin BD by his GP and also 10 mg daily +Atorvastatin to treat high cholesterol
Luca reports episodes of nocturia associated with large pasta meals and Italian pastries, pain in feet at times
Luca ’s symptoms worsen after large meals, especially those high in carbohydrates.
Treatment Luca was initially taking Metformin but stopped because of Lightheadedness/dizziness and loose stools. He is currently using atorvastatin to treat high cholesterol.
• Patient was referred to the diabetes clinic by his GP with present complaint of high blood sugar
• GP tasked diabetic nurses to review Luca ‘symptoms , underlying the fact that Luca shows skepticism regarding the value of taking Metformin tablets , he believes his doctor already knows about his elevated blood sugar levehistory Luca has little knowledge of managing diabetic self-care.
You are advised to structure the essay according to the different consultation phases (from handover or equivalent, to history, to physical examinations, to decisions about tests to results) and expose and interrogate your (or your team’s) reasoning at each stage.
For each consultation phase explain what your hypotheses/differentials were at the start of that phase, how did these inform your history taking or examinations or decisions about tests etc (depending upon the phase of the consultation), and how did the findings from that phase lead you to refine your thinking about differentials (the hypotheticodeductive model). We would recommend that you use tables (listing the differentials, their likelihoods, and the rationale for your reasoning about likelihood) to summarise revisions to your thinking about differentials following each phase. Remember to link tables with the main text of your essay and fully expose your reasoning.
Taking handover or equivalent as an example: explain what information you had at that point, what was your initial thinking about potential differentials and what this was based upon. For example, were there any must-not-miss diagnoses? How likely did you think particular differentials were? Any potential bias, framing etc? anything you might have considered but didn’t?; and go through this process for each phase applying the hypotheticodeductive model.
Exposing diagnostic reasoning clearly throughout: Clearly expose your reasoning processes and how information was processed, not just the decisions made; remember to explain the process of differential diagnosis fully, including the final parts of the funneling process and acknowledge uncertainty in diagnosis throughout.
Interweave theory (and clinical evidence base where appropriate) with your narrative of reasoning, to explain and interrogate your diagnostic reasoning throughout: at each stage you can bring in theory we have covered on the course where relevant to interrogate and critique your narrative of the diagnostic reasoning process; so rather than presenting the theory separately, or merely describing theory, you need to use it to critique your reasoning at each stage/identify where there was room for error in the diagnostic reasoning processes, even if the final diagnosis turned out to be correct. That is, it is important that the theory is applied to you own patient’s case and threaded throughout the account of each phase of the consultation.
PLEASE Follow Essay Plan in attached files AND SEE EXAMPLE OF ESSAY