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I recently started a new job in primary care/internal med and while I have Some experience, I still get overwhelmed at times with the breadth of info I need to know in this field. One area I struggle with is deciding what tests to order to narrow down a differential diagnosis, in the outpatient setting. We don’t have an ultrasound tech or xray in the office so essentially everything has to be referred out And when I’m busy with patients I get a bit flustered deciding what is the most efficient, cost effective and beneficial to the patient. I have medical knowledge but I think when I’m flustered I have more trouble knowing off the top of my head and have to look things up. Any tips on how to conquer this? 

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I recently started a new job in primary care/internal med and while I have Some experience, I still get overwhelmed at times with the breadth of info I need to know in this field. One area I struggle with is deciding what tests to order to narrow down a differential diagnosis, in the outpatient setting. We don’t have an ultrasound tech or xray in the office so essentially everything has to be referred out And when I’m busy with patients I get a bit flustered deciding what is the most efficient, cost effective and beneficial to the patient. I have medical knowledge but I think when I’m flustered I have more trouble knowing off the top of my head and have to look things up. Any tips on how to conquer this? 

 

Hi there... Welcome to Primary Care... Hope you stay... [emoji23]

 

When testing always ask what exactly are you looking for and have a plan for both negative and positive results. I recommend templating your orders where you can alter them PRN in your EMR or if not have a cheat sheet on routine labs etc for whatever you see most frequently (CBC, CMP, Lipids, A1C, TSH for instance) then add anything extra you want to find out about. Same goes for imaging. Be as specific as you can be. Go through your ddx and know or lookup what tests to rule in/out each DDx.

 

Avoid shotgunning unless it is for routines as above.

 

Best wishes! Hang in there.

 

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8 hours ago, Boatswain2PA said:

PC/IM is the broadest of medicine and my hat is off to all that practice that.  In the ED I have all the diagnostics available (stat) and only have to know the first few steps in treatment of any disease.

What did you do before the PC/IM?

I did Peds and urgent care 

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