What is the Surgical Sieve?

The surgical sieve is a framework medical practitioners can use during diagnosis and evaluation to quickly run through possible causes of a medical complaint, covering as many as possible, so they can reach a diagnosis. While sifting through potential causes, doctors can come up with more questions for patients so they can rule various options in or out. They may also think of medical tests they can use to further the diagnostic process.
With the surgical sieve, the doctor considers the symptoms and available information about the patient’s condition, and comes up with a list of all possible causes of those symptoms, running through different anatomical systems to make sure everything is covered. The doctor considers congenital and acquired explanations, as well as neoplastic, traumatic, vascular, neurological, and other causes of disease to start hypothesizing about why the patient feels ill.
Many doctors use a mnemonic to help them remember all the body systems they want to cover, to make sure they don’t miss anything. For example, VITAMIN covers vascular, inflammatory or infective, traumatic, autoimmune, metabolic, iatrogenic or idiopathic, and neoplastic causes of disease. Doctors working in teaching hospitals can use the surgical sieve to prompt their interns and residents, structuring questions to get them thinking about diagnostic techniques and practices.
As a doctor works through the surgical sieve, some potential diagnoses may be struck down immediately; for example, a doctor would come up with a vascular cause, but note that a patient lacks another symptom necessary for diagnosis with that condition. The doctor should develop a list of working potential explanations and can query the patient to check on other symptoms while also running tests to see if any potential candidates are a good fit. The goal is to narrow down the options to one, so the doctor can offer a diagnosis and start discussing treatment options.
While in medical school, people may learn a specific mnemonic from a mentor, and will often use that during clinical practice. Other people invent their own to help themselves remember. One issue with the surgical sieve is the need for flexibility. People need to be able to adjust their answers as new symptoms emerge, and must consider the fact that they are on the wrong track from the start; something people think is a symptom may be an unrelated medical issue, for instance, complicating diagnosis by tricking people into thinking it is caused by the primary condition.

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