So when the person comes to you and they have a particular complaint, you have to think about what it could be. You have to ask the right questions. You have to, sometimes the patients, or the persons, will tell you the necessary information, but sometimes they will go off on something that is probably not as relevant to what you would consider. And so very politely, very gently, you have to lead them in the right direction, seeking the right information. So once you get that information, you formulate what we call differential diagnosis, which is a list of illnesses that can mimic each other and can present with exactly the same symptoms. Once you understand a little bit better based on patient’s history and a very careful examination what you think that the person will have, then you formulate how you’re going to take care of it.
Beginning with the right testing. Certainly blood work is going to be very important followed by, if for example, a person comes in with pain in the right upper quadrant of the abdomen, sonogram becomes an important test. Incidentally, sometimes you will hear ultrasound, sometimes you will hear sonogram, it’s really equivalent. They’re both the same thing. Especially for gallbladder disease, sonogram is very sensitive and very specific. In other words, if it shows that there are gallstones in the gallbladder, they’re usually there. And I would start there. If, however, there is no stones and I suspect, “Hmm, this patient probably has gallbladder disease. I’m a little surprised that they do not have gallstones,” then a referral to a gastroenterologist for evaluation and possible endoscopy may be necessary. When thinking about how we make a diagnosis, what I like to emphasize to our students is that you start with the least invasive first and therefore usually the least expensive. Then going sort of up the ladder to things that are more specific and sometimes more expensive. We have to think about the costs of all the tests that we do. And so we have to, and also for the yield or for the diagnosis that they will help you establish. And so you start with the least expensive and usually the least invasive, and then continuing until you come up with the right diagnosis.