David E. Wade's DIAGNOSIS REMINDERS
Computer-Assisted Diagnosis
Version 3.0

"Satus est initius mederi quam fini." (It is better to doctor at the beginning than at the end.)      Erasmus

Dear Doctor:

As you know, one of the major obstacles in the practice of medicine is trying to remember or having to look up the causes for a particular symptom, sign, or test (SST). DIAGNOSIS REMINDERS will do this for you. It will list the causes for hundreds of SSTs taken from a large sample of patients having that SST, and will list those diagnoses in the approximate order of their decreasing probability (DIAGNOSIS REMINDERS IS THE ONLY COMPUTER-ASSISTED MEDICAL DIAGNOSIS PROGRAM TO HAVE THIS VITAL FEATURE). Thus the more common causes for the SST will be at the top of the list and the less common causes obviously at the bottom of the list. Having this narrowed-down list of diagnostic possibilities makes it much easier to further eliminate the less likely diagnoses and to establish the actual diagnosis(es).

Some of the advantages of using Diagnosis Reminders:

* Helps to make the correct diagnosis.

* Serves as a reminder of the diagnosis(es) to be considered.

* Helps organize the work-up.

* List can be copied to hard copy, electronic medical record, email, etc.

* Serves to educate the patient and family as to what the doctor is doing and why.

* Helps to organizes what could be a perplexing myriad of symptoms, signs, and test results.

* Suggests which diagnoses should be worked-up first.

* Saves time, money, lives.

The algorithm is quite simple. A patient has nausea. The doctor asks the program to list and score the causes of nausea in a decreasing order of probability. Here is the list (the user has requested the top 40 of the 172 causes of nausea):

PROBLEM LIST
NAUSEA
The 40 most likely causes for a large sample of patients having the above problem(s), the diagnoses being listed and scored in an approximate order of probability.

RANK DIAGNOSIS SCORE
1 NAUSEA 100
2 WT. LOSS & ANOREXIA 95
3 ANOREXIA 95
4 GASTROENTERITIS 90
5 GASTRITIS 90
6 ESOPHAGITIS 90
7 HYPERCHLORHYDRIA 80
8 COMMON COLD 70
9 INFLUENZA 70
10 GI/ABD IMAGING DEFEC 50
11 CHRONIC ILLNESS 50
12 DIABETES MELLITUS 20
13 MED/DRUG REACTION 20
14 DIABETIC KETOSIS 20
15 INFECTION 15
16 BILIARY DISEASE 10
17 PEPTIC DISEASE 10
18 FOOD POISONING 10
19 PARALYTIC ILEUS 5
20 CONSTIPATION 5
21 APPENDICITIS 5
22 GASTROINTEST OBSTRUC 5
23 PSYCHIATRIC 5
24 GASTRIC DILATATION 4
25 FEVER 4
26 HIATAL HERNIA 4
27 MALIGNANCY 4
28 FRIGHT 3
29 HYPOTHAL-PITUIT.DIS. 3
30 EXCESSIVE SMOKING 3
31 MIGRAINE 3
32 HI INTRACRAN PRESSUR 3
33 UREMIA/NEPHRITIS 3
34 ANY ACUTE ILLNESS 3
35 DIZZY/VERTIGO 3
36 PYLORIC OBSTRUCTION 3
37 ALLERGY 3
38 PREGNANCY 3
39 DUMPING SYNDROME 3
40 PANCREATITIS 3
172 Diagnoses considered/ 40 Requested/ 40 Listed.

Of 100 cases having nausea, the more likely causes are at the top of the list, and the less likely causes are at the bottom of the list. The clinician is more apt to be right if he considers the higher-listed diagnoses. But if the diagnosis remains elusive the clinician should: (1) review the listed possibilities and if necessary, (2) increase the number of reminders on the list.

Some skeptics have said, “But you give a list of possibilities; I want the one correct diagnosis." Those people are unrealistic. There is no way for a computer to consistently pick one correct diagnosis. Other skeptics have said, “But you don’t know the real incidence of the diagnostic possibilities, and therefore your statistics are fallible.” I agree: I don’t know and neither does anyone else. That is why one should only use approximations. The incidence will vary depending on the type of practice, the geographical location, the season, and a myriad of other variables.  My statistics are approximations. They are based on many years of study and experience plus thousands of opinions and publications by innumerable experts in the medical/surgical field. The doctor merely needs to know the approximate frequency so he can fine-tune the work-up. Other means will then be used to rule in or rule out a specific disease.

DIAGNOSIS REMINDERS is extensive. This program includes the diagnoses to consider for hundreds of the more important symptoms, signs, and test results (SSTs); for example weakness, vomiting, depression, chest pain, hyponatremia, etc.; and more than 1440 diagnoses.

However, in contrast to other programs, DIAGNOSIS REMINDERS does not confound the user with laborious and time-consuming multiple questions, templates, or arbitrary, ill-defined symptoms, physical findings, disease processes, etc. Furthermore, in addition to listing the diagnoses in decreasing order of probability, DIAGNOSIS REMINDERS also gives a numerical score to each diagnosis. Therefore, the doctor can quickly tell more accurately the likelihood of one diagnosis e.g. score of 90, over that of another diagnosis e.g. score of 20. AGAIN, NO OTHER PROGRAM HAS THIS VITAL FEATURE.

DIAGNOSIS REMINDERS keeps it simple! Simply click on DX, then click on or type in one or more SXs, Ss, or Test results. The user can make multiple entries to help narrow down the list of probable diagnoses (scores for the same diagnosis on each list are added together, resulting in a diagnosis having a higher total score). The list will be produced within seconds. The list is easily printed to hard copy and/or copied to an electronic medical record, an email, or to other destinations.

Doctors, hospitals, medical schools, government agencies, etc. around the world use DIAGNOSIS REMINDERS. It was probably the first computer-assisted diagnosis program commercially available. DIAGNOSIS REMINDERS goes directly to the problem---the DIAGNOSIS.

Additionally available free on the Internet, are such sources as www.pubmed.gov which describes the disease, diagnosis, treatment, etc. Many other programs including textbooks, ICD/CPT codes, journals, etc. are kept up to date, and are inexpensively available on the Internet.

DIAGNOSIS REMINDERS is mailed to you. Your computer has a 3.5" disk drive, a CD drive, or both? Your mailing address is:

If you are not completely satisfied with DIAGNOSIS REMINDERS, return the disk within 30 days and receive a full refund. Price: $50.00 U.S. currency, check or money order, payable to David E. Wade, M.D. and mailed to the address below. Inexpensive updates (indicated as a new version) are made on the few occasions that a significant, documented, new disease is described, or when there are significant program improvements.

Yours truly,

David E. Wade, M.D.

466 S. Goodlett

Memphis, TN 38117

David E. Wade, M.D.
Author:
WADE'S DIFFERENTIALS: an aid to diagnosis, Astor-Honor Inc., New York, 1971.
COMPUTER-ASSISTED DIAGNOSIS SYSTEM
Board Certification, American Board of Medical Specialists:
       Internal Medicine 1966.
       Endocrinology & Metabolism 1972.

INDEX FOR DIAGNOSIS REMINDERS

ABDOMINAL DISTENTION
ABDOMINAL PAIN
ACID INDIGESTION
ACIDOSIS
ADENOPATHY, LOCAL OR GENERALIZED
AGITATION
AGRANULOCYTOSIS
ALKALINE PHOSPHATASE HIGH
ALKALINE PHOSPHATASE LOW
ALOPECIA
AMBIGUOUS GENITALIA
AMENORRHEA/HYPOMENORRHEA
AMNESIA
ANDROGENS ELEVATED
ANEMIA
---ANEMIA PSEUDO-IRON DEFICIENCY
---HEMOLYSIS
---IRON DEFICIENCY is included in microcytic/hypochromic anemia
---MICROCYTIC HYPOCHROMIC ANEMIA
---MACROCYTIC ANEMIA
---NONSPECIFIC ANEMIA
---NORMOCYTIC NORMOCHROMIC
ANHYDROSIS
ANOREXIA
ANXIETY
APPETITE
-----INCREASED
-----DECREASED
APPREHENSION
ARM PAIN
ARRHYTHMIA
---ATRIAL FIBRILLATION
---BRADYCARDIA
---EXTRASYSTOLES
---HEART BLOCK
---TACHYCARDIA
ARTHRITIS/ARTHRALGIA
AUTOIMMUNE DISORDERS (DESTRUCTIVE/NOT HIV)

BACK PAIN
BAD BREATH
BAD TASTE
BALDNESS
BLEEDING

-----EPISTAXIS
-----GI
-----HEMOPTOSIS

-----SKIN (ECCHYMOSIS, PURPURA, PETECHIAE)
-----THROMBOCYTOPENIA
-----VAGINAL, EXCESSIVE, INAPPROPRIATE
BLINDNESS/POOR VISION
BLOATING, ABDOMINAL
BLOOD
-----AGRANULOCYTOSIS
-----ANEMIA
-----EOSINOPHILIA
-----EOSINOPHILIA PLUS LUNG INFILTRATE
-----HEMOLYSIS
-----IN SKIN (ECCHYMOSIS, PURPURA, PETECHIAE)
-----IN STOOL (GI HEMORRHAGE)
-----IN SPUTUM
-----IN VOMITUS (GI HEMORRHAGE)
-----LEUKOPENIA
-----NASAL
-----NEUTROPENIA
-----PANCYTOPENIA
-----POLYCYTHEMIA
-----THROMBOCYTOPENIA
-----VAGINAL, EXCESSIVE/INAPPROPRIATE
BLOOD PRESSURE
-----HIGH
-----HYPOTENSION
----------MILD &/or ORTHOSTSTIC
-----SHOCK
BONE, WEAK (OSTEOPOROSIS and OSTEOMALACIA)
BREAST
-----GALACTORRHEA
-----GYNECOMASTIA
BREATH, MALODOROUS
BRITTLE DIABETES MELLITUS
BRUISES, SKIN (ECCHYMOSIS, PURPURA)
BUN ELEVATED


CALCIFICATION
-----KIDNEY
-----NEPHROCALCINOSIS
CALCIUM
-----BLOOD, HIGH
-----BLOOD, LOW
CARDIAC
CARPOPEDAL SPASM
CATARACTS
CEREBRAL FUNCTION IMPAIRED
CHEST PAIN
CHOLESTEROL ELEVATED
COMA/STUPOR
CONFUSION
CONSTIPATION
COUGH
CRAMP, MUSCLE


DEAFNESS and/or EAR NOISE
DELUSIONS
DEMENTIA
DENTAL
DEPRESSION
DIABETES MELLITUS, CAUSES OF
-----INCLUDED IN GLUCOSE, HIGH (HYPERGLYCEMIA)
-----POOR CONTROL (BRITTLE DIABETES)
DIARRHEA
DIPLOPIA
-----BINOCULAR
-----MONOCULAR
DIZZINESS
DRY MOUTH
DRY SKIN
DWARFISM
DYSPHAGIA
DYSPNEA
DYSURIA

EAR, NOISE IN AND/OR DECREASED HEARING
ECCHYMOSIS
EDEMA
ENCEPHALOPATHY
    (The ranking/or scoring may vary slightly for these.)
    (Use COMA/STUPOR for any degree of unresponsiveness.)
-----AMNESIA, ANXIETY, CONFUSION, DELUSIONS,
-----DEMENTIA, DEPRESSION, HALLUCINATIONS,
-----IMPAIRED INTELLIGENCE, IRRITABILITY,
-----POOR MEMORY, NERVOUSNESS, NEUROSIS,
-----PERSONALITY CHANGE, PSYCHOSIS   

EOSINOPHILIA
EOSINOPHILIA PLUS LUNG INFILTRATE
EPILEPSY
EPISTAXIS
ERYTHEMA
ERYTHREMIA
EYE
-----BLIND/POOR VISION
-----CATARACTS
-----DIPLOPIA BINOCULAR
-----DIPLOPIA MONOCULAR
-----EXOPHTHALMOS
-----LARGE PUPIL
-----PERIORBITAL EDEMA
-----PHOTOPHOBIA


FACE PAIN
FAINT/SYNCOPE
FATIGUE
FAT, EXCESS (OBESITY)
FATTY LIVER
FEVER
FEVER, FUO
FERTILITY
FINGERNAILS, DISORDERS OF
FLUID RETENTION
-----AROUND HEART
-----AROUND LUNG
-----FLUID RETENTION, FEET/LEGS
-----GENERALIZED
-----INAPPROPRIATE ADH SYNDROME
-----PERIORBITAL
FRICTION RUB


GALACTORRHEA
GI HEMORRHAGE
GENITALIA, AMBIGUOUS
GLUCOSE, BLOOD
-----HYPERGLYCEMIA
-----HYPOGLYCEMIA
GOITER
GROWTH
-----SHORT OR DELAYED
-----TALL OR RAPID
GYNECOMASTIA


HAIR
-----ALOPECIA
-----AXILLARY/PUBIC HAIR LOSS IN FEMALE
-----HIRSUTISM
--------IF SEVERE, SEE VIRILISM
-----SEX HAIR, LOSS IN MALE
HALITOSIS
HALLUCINATIONS
HEADACHE
HEARING IMPAIRED and/or EAR NOISE
HEART
-----ARRHYTHMIA
-----CARDIOMYOPATHY
-----CHEST PAIN
-----DYSPNEA
-----EFFUSION PERICARDIAL
-----EDEMA
-----EXTRASYSTOLES
-----HEART BLOCK
-----HEART FAILURE/CARDIOPATHY
-----HYPERTENSION
-----HYPOTENSION
-----MYOCARDITIS (CARDIOPATHY, MYOCARDIOPATHY)
-----ORTHOPNEA
-----PAROXYSMAL NOCTURNAL DYSPNEA
-----PERICARDIAL EFFUSION and/or PERICARDITIS
-----SHOCK
HEIGHT
HEMOLYSIS
HEMOPTOSIS

HEMORRHAGE EPISTAXIS
HEMORRHAGE GI
HEMORRHAGE HEMOPTOSIS
HEMORRHAGE SKIN ECCHYMOSIS, PURPURA, PETECHIAE
HEMORRHAGE THROMBOCYTOPENIA
HEMORRHAGE VAGINAL
HEPATOMEGALY, INCLUDED IN LIVER DISEASE
HICCUPS
HIP PAIN
HIRSUTISM
-----IF SEVERE, SEE VIRILISM
HOARSNESS/VOICE CHANGE
HUNGER
HYPERANDROGENISM
HYPERCALCEMIA
HYPERCHOLESTEROLEMIA
HYPERGLYCEMIA
HYPERHYDROSIS
HYPERKALEMIA
HYPERMETABOLISM
HYPERPNEA
HYPERTENSION
HYPOCALCEMIA
HYPOGLYCEMIA
HYPOGONADISM IN FEMALE (INCLUDED IN AMENORRHEA)
HYPOGONADISM IN MALE
HYPOKALEMIA
HYPONATREMIA
HYPOPHOSPHATEMIA
HYPOTENSION (USE SHOCK IF IN SHOCK)


ICTERUS
ILEUS
IMPOTENCY, MALE
INAPPROPRIATE ADH SYNDROME
INFERTILITY
-----FEMALE
-----MALE (STERILITY)
INSOMNIA
INTELLIGENCE IMPAIRED
INTESTINAL BLEEDING
IRRITABILITY
ITCH


JAUNDICE
JOINT PAIN


KIDNEY OR BLADDER STONES
KIDNEY FAILURE (NEPHRITIS/NEPHROPATHY)


LEG PAIN
LEUKOPENIA
LIBIDO/POTENTIA DECREASED
LIVER DISEASE
LOWER EXTREMITY PAIN
LUNG
-----COUGH
-----DYSPNEA
-----HEMOPTOSIS
-----INFILTRATE PRESENT
-----ORTHOPNEA
-----PAROXYSMAL NOCTURNAL DYSPNEA
-----PULMONARY INFILTRATE
-----PULMONARY INFILTRATE PLUS EOSINOPHILIA
-----PLEURAL EFFUSION/PLEURITIS
-----SHORT OF BREATH/RAPID BREATHING
-----STRIDOR
-----WHEEZING RESPIRATIONS
LYMPHADENOPATHY, LOCAL OR GENERALIZED
LYMPHOPENIA


MASCULINIZATION
MEMORY POOR
MENSTRUAL PERIODS
-----ABSENT or DECREASED PERIODS
-----BLEEDING EXCESSIVE or INAPPROPRIATE
MOUTH
-----BAD TASTE/HALITOSIS
-----DENTAL DISORDER (ABNORMAL TEETH)
-----DRY
-----EXCESS SALIVA (PTYALISM)
-----GUM DISORDERS
-----PTYALISM
MUSCLE
-----CRAMP/SPASM
-----IRRITABILITY (INCLUDED IN SEIZURES)
-----MYOPATHY
      (CONSIDER MUSCLE PAIN, WEAKNESS, PARALYSIS, PERIPHERAL
      NEUROPATHY)
-----PAIN
       (CONSIDER LOWER EXTREMITY PAIN, UPPER EXTREMITY PAIN, MUSCLE 
       SPASM, MYOPATHY, PERIPHERAL NEUROPATHY)
-----PARALYSIS/INCOMPLETE PARALYSIS,EXTREMITY
       CONSIDER MYOPATHY, PERIPHERAL NEUROPATHY, WEAKNESS  
       GENERALIZED)
-----TREMOR


NAILS, DISORDERS OF
NAUSEA
NECK PAIN, POSTERIOR
NERVOUSNESS
NEPHRITIS
NEUROPATHY, PERIPHERAL
NEUTROPENIA
NIGHT SWEATS
NIPPLE DISCHARGE
NOCTURIA
NOSE BLEEDS
NUMBNESS (PARESTHESIAS)


OBESITY
OSTEOPOROSIS (OSTEOPENIA) INCLUDES OSTEOMALACIA
OVARIAN FAILURE

PAIN
-----ABDOMINAL
-----BACK
-----CHEST
-----FACE PAIN
-----HEAD (HEADACHE)
-----JOINT/ARTHRITIS/ARTHRALGIA
-----LOWER EXTREMITY (INCLUDES HIP AREA)
-----MUSCLE PAIN
-----NECK PAIN, POSTERIOR
-----TESTES PAIN
-----UPPER EXTREMITY (INCLUDES SHOULDER AREA)
PANCYTOPENIA
PARALYSIS/INCOMPLETE PARALYSIS, EXTREMITY (CONSIDER MYOPATHY,
PERIPHERAL NEUROPATHY, WEAKNESS GENERALIZED)
PARESTHESIAS
PAROTID OR SALIVARY GLAND ENLARGEMENT
PERICARDIAL EFFUSION and/or PERICARDITIS
PERSPIRATION
-----ANHYDROSIS
-----NIGHT SWEATS
-----PERSPIRATION, INCREASED
PERSONALITY CHANGE
PETECHIAE
PHOSPHATASE (ALKALINE)
-----HIGH
-----LOW
PHOSPHATE
-----HYPERPHOSPHATEMIA
-----HYPOPHOSPHATEMIA
PHOTOPHOBIA
PHOTOSENSITIVITY OF SKIN
PLATELETS, LOW
PLEURAL EFFUSION/PLEURITIS
POLYCYTHEMIA
POLYURIA
POTASSIUM
-----BLOOD, ELEVATED
-----BLOOD, LOW
PSYCHOSIS
PRURITUS
PTYALISM
PUPIL, DILATED
PURPURA

SALIVARY GLAND ENLARGEMENT
SEIZURES
SHOCK
SHOULDER PAIN
SINGULTUS
SKIN
-----BRUISES EASILY (ECCHYMOSIS, PURPURA,PETECHIAE)
-----DRY
-----ERYTHEMA
-----HIRSUTISM
--------IF SEVERE, SEE VIRILISM
-----ITCH
-----JAUNDICE
-----PARESTHESIAS
-----PERSPIRATION DECREASED
-----PERSPIRATION INCREASED
-----PETECHIAE
-----PHOTOSENSITIVITY
-----PIGMENTATION
--------HYPERPIGMENTATION
--------HYPOPIGMENTATION
-----PURPURA
-----TELANGIECTASIA
-----ULCER GENITALIA
-----ULCER SKIN
-----URTICARIA (WHEALS)
-----YELLOW
SLEEP, POOR
SODIUM, BLOOD, LOW
SPASM, MUSCLE
SPINE, VERTEBRAL BODY COLLAPSE/DESTRUCTION
SPLEEN, LARGE
SPLENOMEGALY, GIANT
STERILITY
-----FEMALE (INFERTILITY)
-----MALE
STOMACH BLEEDING
STOOL, BLOOD IN
SWALLOWING DIFFICULTY
SWEAT
SWELLING
SYNCOPE/FAINT


TASTE, BAD TASTE IN MOUTH
TEETH ABNORMAL
TELANGIECTASIA
TESTES, HYPOGONADISM
TESTES PAIN
TESTOSTERONE ELEVATED
TETANY
THROMBOCYTOPENIA
THYROID ENLARGEMENT
TINNITUS
TIREDNESS, GENERALIZED
TOENAILS, DISORDERS OF
TREMOR


ULCER, SKIN
UREMIA
URIC ACID HIGH
URINE
-----DYSURIA, FREQUENCY***
-----NOCTURIA
-----POLYURIA
-----REDDISH URINE***
URTICARIA


VAGINAL BLEEDING EXCESSIVE/INAPPROPRIATE
VERTEBRAL BODY COLLAPSE/DESTRUCTION
VIRILISM
-----ANDROGENS ELEVATED
--------if younger than puberty age, add GROWTH TALL OR RAPID
VERTIGO
VISCERAL NEUROPATHY
VISION, POOR
VOICE, CHANGE IN/HOARSNESS
VOMITING


WEAKNESS, GENERALIZED
WEIGHT LOSS
-----ASSOCIATED WITH POOR APPETITE
-----ASSOCIATED WITH NORMAL OR INCREASED APPETITE
WHEEZING RESPIRATIONS
WHITE BLOOD CELL COUNT LOW


XEROSIS
XEROSTOMIA

YELLOW SKIN

Computer-Assisted Diagnosis System.

*** Only one or a few differential diagnoses.