1. 10/25/2015Prof. Sameer Bafaqeeh1 Medical Decision Making Presented by: Professor Sameer Bafaqeeh Otolaryngology Department

2. 10/25/2015Prof. Sameer Bafaqeeh2 Medical Decision Making  Diagnosis/Management Options  Amount/Complexity of Data  Risks of Complications, Morbidity, Mortality Mortality

3. 10/25/2015Prof. Sameer Bafaqeeh3 Diagnosis/Management Options More commonly known to be “problems” - includes identifying whether any of the following tests were performed and assigning the appropriate “points” to them: - includes identifying whether any of the following tests were performed and assigning the appropriate “points” to them:

4. 10/25/2015Prof. Sameer Bafaqeeh4 Dx/Management Option Categories self-limited or minor (problem) (1 point) self-limited or minor (problem) (1 point) established problem, stable, improved (1 point) established problem, stable, improved (1 point) established problem, worsening (2 points) established problem, worsening (2 points) new problem, no additional work-up planned (3 points) new problem, no additional work-up planned (3 points) new problem, additional work-up planned (4 points) new problem, additional work-up planned (4 points)

5. 10/25/2015Prof. Sameer Bafaqeeh5 Amount and/or Complexity of Data Includes: Clinical lab tests Clinical lab tests Radiology tests Radiology tests Tests in the Medicine section of CPT Tests in the Medicine section of CPT Discussion of test results with performing physicians Discussion of test results with performing physicians Decision to obtain old records Decision to obtain old records Review and summary of old records Review and summary of old records Independent visualization Independent visualization

6. 10/25/2015Prof. Sameer Bafaqeeh6 Risk of Complications, Morbidity, Mortality Minimal Low Moderate High

7. 10/25/2015Prof. Sameer Bafaqeeh7 Table of Risk Refer to handout

8. 10/25/2015Prof. Sameer Bafaqeeh8 MDM Grid DX/Mgmt0-1234+ Data0-1234+ RiskMinLowModHigh Type of DecisionMakingStfwdLowModHigh

9. 10/25/2015Prof. Sameer Bafaqeeh9 Examples

10. 10/25/2015Prof. Sameer Bafaqeeh10 Self limited or minor

11. 10/25/2015Prof. Sameer Bafaqeeh11 6 y/o female presents with 2 small raised areas on R thigh. No fever. Exam: GEN: alert, NAD HEENT: TM’s normal, Nares- clear HEART: RRR LUNGS: CTA ABD: Soft EXT: Normal with exception of 2-pin point, slightly red, raised areas on R thigh Dx: Insect bite Return to clinic if problem occurs

12. 10/25/2015Prof. Sameer Bafaqeeh12 Established problem, stable, improved

13. 10/25/2015Prof. Sameer Bafaqeeh13 Patient is a 55 year old established patient who returns today for follow-up of his hypertension. He has done well since last visit w/o symptoms consistent w/angina or congestive heart failure.

14. 10/25/2015Prof. Sameer Bafaqeeh14 Established problem, worsening

15. 10/25/2015Prof. Sameer Bafaqeeh15 CC: still with abdominal pain 6 yr old with persistent abdominal pain that started initially with vomiting and fever. Going on 3 weeks. Tums has not improved pain. No diarrhea. Pain now epigastric.

16. 10/25/2015Prof. Sameer Bafaqeeh16 New problem, no additional work-up planned

17. 10/25/2015Prof. Sameer Bafaqeeh17 60 yr old WM white bumps on face, has had several milia removed in the past. C/O small area on left side of nose. No bleeding, no itching, no history of skin cancer. Allergic to sulfa drugs. Exam: L nasal bridge - skin colored papule with sebaceous glands & pore accentuation Forehead and nasolabial fold – white smooth papule/pustule L cheek - irritated scaly 4 mm papule Chest – erythematous vesicular papule

18. 10/25/2015Prof. Sameer Bafaqeeh18 1. Prob Sebaceous Hyperplasia- reassurance return if changes 2. Milia 3. SK – reassurance 4. Cherry angioma – reassurance

19. 10/25/2015Prof. Sameer Bafaqeeh19 New problem, additional work-up planned

20. 10/25/2015Prof. Sameer Bafaqeeh20 58 y/o female presents with B anterior thigh pain when walking short distances. Exam: Cranial nerves: intact Reflexes: intact Sensation: intact to touch/vibration Strength: decreased in Quads with some atrophy noted MRI ordered NCV/EMG ordered for eval of nerves L3 & L$ Dx: Pain in limb