Our goal in creating Symptom to Diagnosis was to develop an interesting, practical, and informative approach to teaching the diagnostic process in internal medicine. Interesting, because real patient cases are integrated within each chapter, complementing what can otherwise be dry and soporific. Informative, because Symptom to Diagnosis articulates the most difficult process in becoming a physician: making an accurate diagnosis. Many other textbooks describe diseases, but fail to characterize the process that leads from patient presentation to diagnosis. Although students can, and often do, learn this process through intuition and experience without direct instruction, we believe that diagnostic reasoning is a difficult task that can be deciphered and made easier for students. Furthermore, in many books the description of the disease is oversimplified, and the available evidence on the predictive value of symptoms, signs, and diagnostic test results is not included. Teaching based on the classic presentation often fails to help less experienced physicians recognize the common, but atypical presentation. This oversight, combined with a lack of knowledge of test characteristics, often leads to prematurely dismissing diagnoses.
Symptom to Diagnosis aims to help students and residents learn internal medicine and focuses on the challenging task of diagnosis. Using the framework and terminology presented in Chapter 1, each chapter addresses one common complaint, such as chest pain. The chapter begins with a case and an explanation of a way to frame, or organize, the differential diagnosis. As the case progresses, clinical reasoning is clearly articulated. The differential diagnosis for that particular case is summarized in tables that delineate the clinical clues and important tests for the leading diagnostic hypothesis and important alternative diagnostic hypotheses. As the chapter progresses, the pertinent diseases are reviewed. Just as in real life, the case unfolds in a stepwise fashion as tests are performed and diagnoses are confirmed or refuted. Readers are continually engaged by a series of questions that direct the evaluation. Each chapter contains several cases and includes a diagnostic algorithm. Symptom to Diagnosis can be used in three ways. First, it is designed to be read in its entirety to guide the reader through a third-year medicine clerkship. We used the Core Medicine Clerkship Curriculum Guide of the Society of General Internal Medicine/Clerkship Directors in Internal Medicine to select the symptoms and diseases we included, and we are confident that the text does an excellent job teaching the basics of internal medicine.