Illness Scripts 101: The Medical Student’s Guide to Quickly Creating a Differential Diagnosis

When I started medical school three years ago, I did not know that I was entering a profession in which I would constantly race the clock. However, in the era of expanding patient volumes, it has become imperative for health professionals to use their time efficiently. So, what is a young, energetic, and eager medical student to do when the attending physician assigns 20 minutes to see a patient and present a differential diagnosis with a plan? Use illness scripts!

Illness scripts are mental cue cards that health professionals use to represent a certain disease, like they’re described in a recent Academic Medicine Last Page. When used throughout our training, they are designed to help us organize our biomedical knowledge into retrievable representations of diseases. From these, we can quickly create a differential diagnosis.  On this cue card, there are three major factors: epidemiology, pathophysiology, and clinical syndrome (i.e., signs and symptoms). Sometimes, I like to think of patients as my partners in the game of Taboo, where the object is for both of us to arrive at their diagnosis through asking questions. In the board game, my partner uses acceptable words to paint a picture and describe a key term. Then, I have to guess the term. Likewise, when I meet with patients, I use the words my patients say, and their clinical syndrome to align with an illness script.

At this point, I bet you’re wondering, “How do I incorporate illness scripts into my daily routine?” Here are my top ten ways to use illness scripts:

Before you see your patient:

1. Look up the pertinent history, lab results, and imaging pertaining to his or her chief complaint.

2. Ask the patient’s nurse about noninvasive tests you might immediately suggest, for example urinalysis, or a rapid strep test.

3. Think about which physical exams you would want to complete and what you might illicit from these exams.

After your patient interview, your clinical picture improves. You can use your illness script to:

4. Prioritize and direct further questions.

5. Tailor your physical exam.

6. Anticipate the complications associated with your differential (e.g., worsening pain, diarrhea).

After you examine your patient, your illness scripts will lead you to select diagnoses for your differential:

7. Present your top three diagnoses to your attending.

8. Order labs or imaging to confirm or negate a diagnosis.

9. Consult appropriate specialists.

10. Recommend a treatment plan.

Most students use illness scripts without even knowing it. Being aware of illness scripts allows you to discuss and tailor them to your daily practice.

By: Marian Fagbemi

Marian Fagbemi is a fourth-year medical student, University of Texas Health Science Center at San Antonio, San Antonio, Texas.

Further Reading

  1. Gavinski K, Covin YN, Longo PJ. Learning how to build illness scripts. Acad Med. 2019;94:293. doi:10.1097/acm.0000000000002493.