Why Diagnostic Systems Matter · Clinical Exercise

What Goes in the File

Four pieces of correspondence, which is where the principles in this module either hold or quietly do not. A referral note you build line by line, a physician asking you to confirm a diagnosis the criteria do not support, ninety seconds in a case conference, and what you tell the client the label means.

What this exercise practises

Writing diagnostic language at the level of confidence you are actually entitled to, declining to confirm a diagnosis the criteria do not support without abandoning the client's access to care, contributing to a team conversation that has reached the wrong conclusion, and being transparent with a client about what a diagnosis does not tell her.

Every task here is something you will do in writing, with your name on it, and most of the wrong answers are the ones that look most reasonable at the time.

Estimated time to complete this exercise: 30 minutes

1The referral note
2The letter
3The conference
4The client
5Your sentence
6Close

Before you begin

How this one works

This one is correspondence and record-keeping, which is where the principles in this module either hold or quietly do not. A referral note, a letter from a physician, a case conference, and a conversation with the client about what the label means.
Part 1 asks you to build an actual referral note. You choose which lines go in, and the reveal shows you the note you built next to the one you should have built.
Part 2 is a letter from a family physician asking you to confirm a diagnosis that the criteria do not support. The most tempting answer is the one most clinicians have been tempted by.
Parts 3 and 4 are the case conference and the client conversation. Part 5 is one sentence you have to write yourself, and you cannot finish without it.
Nothing is graded and nothing is recorded. Reloading starts it again.

The diagnostic framework is a map and no map is the territory. The territory is the full biopsychosocial reality of a specific person, in a specific relationship, at a specific point in their life. This exercise is about using the map intelligently in the four places where you actually have to write it down.

References

  1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
  2. Bornstein, J., Goldstein, A. T., Stockdale, C. K., Bergeron, S., Pukall, C., Zolnoun, D., & Coady, D. (2016). 2015 ISSVD, ISSWSH and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Obstetrics & Gynecology, 127(4), 745–751. https://doi.org/10.1097/AOG.0000000000001359
  3. Morin, M., Carroll, M. S., & Bergeron, S. (2017). Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodynia. Sexual Medicine Reviews, 5(3), 295–322. https://doi.org/10.1016/j.sxmr.2017.02.003
  4. Pukall, C. F., Goldstein, A. T., Bergeron, S., Foster, D., Stein, A., Khera, M., & Bachmann, G. (2016). Vulvodynia: Definition, prevalence, impact, and pathophysiological factors. Journal of Sexual Medicine, 13(3), 291–304. https://doi.org/10.1016/j.jsxm.2016.01.021
  5. World Health Organization. (2022). International classification of diseases for mortality and morbidity statistics (11th rev.). https://icd.who.int