PEDIATRICS Vol. 80 No. 1 July 1987, pp. 118-119
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Clinical Guidelines for the Pediatrician

Gunnar B. Stickler MD1

1 From the Department of Pediatrics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Much of clinical medicine is still based on empiricism, particularly the approach to diagnosis. One aspect of diagnosis that is talked about is the intuition of the experienced clinician. Most physicians working in a referral center have developed certain guidelines for themselves and have adopted suggestions from their teachers and colleagues. Some of these rules are recorded in books and essays, and others are passed by word of mouth from one generation of physicians to the next. It should not be necessary to emphasize that these are rules and not laws. Indeed, exceptions occur, and if there are not too many, they tend to prove the validity of a rule.

I want to suggest some of the rules I have found useful. It is impossible to state who was the author of them, even if I might claim that most of them are my own. I hope they generate responses and discussion, which perhaps will lead to deletions, additions, and refinements.

1. Determine the true "chief complaint" and do not accept previous diagnoses as the chief complaint. For example, if a patient presents because of urinary frequency and painful urination, he or she is not complaining of a "urinary tract infection." The chief complaint should be listed in simple English as what the patient or parent states as the reason for consulting the physician and not as a previous diagnosis.

2. Listen to the mother or the primary caretaker; these persons are the best observers and describe the situation well.

Submitted on October 30, 1986
Accepted on January 12, 1987




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