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Why is it important to have differential diagnoses when you first see a patient?

First day at your adults SLT job at a stroke ward, you’re raring to go.

You finished ward round meeting, and you look through the list of patients you need to see for the day. Many of them are new referrals.

What do you do?

You decide to look at patient’s case history or their most recent notes.

But then you realise that patient notes are not even available!! Because you just finished ward rounds and they are being used somewhere! (It happens… Quite often).

What do you do then?

Panic! You don't have all the information! How can you do your job?

Relax - you do have some information, even the most barebones of it. This is a stroke ward, so all patients here would have arrived due to a stroke.

So, come up with some differentials.

Our role during assessment is then to:

  1. find out more about the patient

  2. rule out the differential diagnoses that you have just come up

  3. And see if your clinical symptoms match up with the medical diagnosis

Here is an example:

Patient A - stroke lesion

Potential differential communication diagnoses:

  • Receptive aphasia

  • Expressive aphasia

  • Apraxia of speech vs oral apraxia

  • Dysarthria

  • Cognitive communication disorder

  • Dysphonia or aphonia

What assessments do you then do to rule these out?

Once you’ve done the assessments, complete this sentence:

Based on _______ assessment, (insert diagnosis) is not likely, because ______.

Use the process of elimination to narrow the diagnoses down.

Ta-da! You now have a better picture of the patient’s likely clinical diagnosis and your reasoning behind it!

Why is formulating differential diagnoses during the assessment process important?
  1. Humans are excellent at pattern recognition. However, this also means that we may potentially become uncertain when things don’t fit neatly inside a diagnostic ‘category’. Using this process, you may be less likely to miss out any additional needs or concerns.

  2. Remember the above potential diagnoses are not mutually exclusive, it is important to identify what symptoms fall under what diagnosis (i.e. patient presents with mild/moderate/severe X characterised by… ).

  3. This may also help to prompt components you may have overlooked or missed. If you are uncertain between two diagnoses, is it because there are other components that you can assess further?

  4. This also helps to reduce the chance of missing differentials that have similar clinical presentations.

Despite that, don’t forget to keep an open-mind! Diagnoses and presentations change all the time, and you need to reassess your patient every time there is new information. It is okay to change your diagnosis! We are all humans (or unicorns) after all!

Good luck!


Is this process something you are familiar with, or has it inspired you to try it out next time you have a new patient to see?

Let us know your thoughts! Email or link with us through our socials @speechtherapistslinks


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