Trajectory Thinking > Diagnostic Hunting
Definition
Also known in the literature as prognostic reasoning & illness trajectory – it involves focusing on the likely course of a patient’s illness rather than pursuing diagnostic certainty at all costs.
How to Apply
Asking the right questions gives you the right perspective. Ask yourself – ‘where is this patient heading and how should that influence my management?’ instead of ‘can I arrive at the perfect diagnosis?’
If we become too focused on naming the disease then we are at risk of losing sight of where the patient is heading and what they need. Often times, the reason we struggle to discharge patients (when its safe) or stop investigating is the discomfort with diagnostic uncertainty, but if we consider trajectory this becomes easier.
For example, a young patient with negative tests and a positive trajectory – build confidence in discharging with safety netting or an elderly patient with frailty / multi-morbidity with a negative trajectory – holistic discussions regarding BSC approach. This will become more evident in the clinical cases section.
The Acute Mind 