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Thirty years of illness scripts: Theoretical origins and practical applications.Med Teach. ReferencesĬharlin B, Boshuizen HP, Custers EJ, Feltovich PJ. Diseases encountered less frequently will have less robust scripts. This iterative process continued throughout a clinician’s career, adds depth, precision and differentiating power to the foundational scripts developed during training (5). They develop a list of disease mimickers to consider when an illness script of a particular diagnosis is invoked.Example: Chronic obstructive pulmonary disease (COPD) exacerbation and congestive heart failure resemble CAP.They emphasize distinguishing characteristics whose presence or absence significantly alters the likelihood of the diagnosis, and helps differentiate it from another related diagnosis. Example: A lobar infiltrate on chest x-ray without cardiomegaly or cephalization of vessels is highly suggestive of CAP and makes congestive heart failure less likely.They encode a predictive value for each feature of the disease, enabling them to estimate the likelihood of a diagnosis when that feature is present or absent. Example: The absence of a fever does not exclude the diagnosis of community acquired pneumonia (CAP) in an elderly patient.With experience, providers hone their illness scripts in three important ways (5): Post upper respiratory tract viral infectionĪntibiotics typically lead to improvement over days.Most commonly caused by Streptococcus pneumoniae.
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An illness script is an organized mental summary of a provider’s knowledge of a disease (1-3).