|The doctor responds to the information available with few if any ideas about what the problem might be.||The doctor responds to the information available with an adequate (1) range of reasonable (2) ideas about what the problem might be.|
|Has little understanding of this.||Attempts to do this but is not yet skilful and sometimes runs into difficulty.||Attempts to do this and is usually successful but recognises his/her limitations.||Perfect|
The doctor’s initial ideas about the problem:
|(a)||Include all the common and important causes of the symptoms reported and the signs elicited.|
|(b)||Incorporate, and do not reject, unexplained findings or apparent inconsistencies.|
|(c)||Take into account the patient’s ideas about the problem.|
Notes for raters
(1) ‘Adequate’ means that the ideas include all the commonand important causes of the symptoms reported and the signs elicited.
(2) ‘Reasonable’ ideas are those that are either highly likely,or if relatively unlikely, are important enough to warrant early exclusion (eg’cancer until proved otherwise’). This area is best assessed in case discussionor with MEQ’s in answer to key questions such as “What do you think itcould be?”, “What are the possibilities?”.