Primary Care Differential Diagnosis Builder
Build systematic, evidence-based differential diagnoses for primary care presentations
What You Can Do
You can systematically generate ranked differential diagnoses for presenting complaints (chest pain, dyspnea, abdominal pain, headache, joint pain, fatigue) by applying evidence-based clinical decision rules and risk stratification. The skill helps you identify red flags that change management priority, justify test selection to supervising physicians, and document diagnostic reasoning in the medical record while reducing anchoring bias and ensuring comprehensive consideration of serious diagnoses.
Features
builds ordered lists of diagnoses ranked by likelihood given patient risk factors and presentation
applies validated decision rules (HEART score for chest pain, PERC criteria for PE, etc.) to guide diagnostic efficiency
highlights concerning features that mandate urgent workup or specialist referral regardless of likelihood
incorporates age, comorbidities, smoking history, and other factors that shift diagnostic probability
justifies which tests to order, which to defer, and cost-effective sequencing based on pre-test probability
ensures systematic consideration of serious diagnoses before settling on reassuring explanations
generates clinical reasoning narratives suitable for medical records and communication with supervising physicians
indicates when presentation warrants specialist evaluation or shared decision-making
Example Output
Example 1: 47-year-old with atypical chest pain
Top Differential Diagnoses:
- Stable angina (HEART score: 4/10, low risk) — CTA coronary calcium score, consider stress test if high CAD risk
- GERD (typical triggers: postprandial, supine position) — trial PPI, reassess
- Musculoskeletal pain (reproducible on palpation) — physical exam confirms
- Anxiety-related chest pain — after cardiac causes excluded
Red Flags to Rule Out: Acute coronary syndrome (obtain EKG, troponin if any high-risk features), aortic dissection (sudden onset, back pain, HTN urgency)
Example 2: 34-year-old with dyspnea and leg swelling
Top Differential Diagnoses:
- DVT with PE (Wells score: 5/10, moderate risk; D-dimer → CTA PE protocol) — hypercoagulable state workup
- Right heart failure (elevated JVP, hepatomegaly) — echo, BNP
- Lymphedema (unilateral, chronic course) — ultrasound compression
- Medication-related (recent oral contraceptive) — risk factor analysis
Red Flags: Hemodynamic instability, hypoxemia refractory to oxygen → ICU transfer criteria
What's Included
- Primary Care Differential Diagnosis Builder SKILL.md instruction file with clinical decision framework:
- Presentation-based templates for chest pain, dyspnea, abdominal pain, headache, joint pain, and fatigue:
- Clinical decision rule quick-reference cards (HEART, Wells, PERC, Ottawa, etc.):
- Red flag checklist organized by presentation type:
- Diagnostic workup sequencing flowcharts with cost-effectiveness guidance:
- Documentation templates for medical record entry and physician communication:
- Risk stratification matrix by age, comorbidities, and social factors:
Who It's For
- Physician assistants in primary care, urgent care, and family medicine settings
- Nurse practitioners developing differential diagnoses independently
- Medical residents and students building diagnostic reasoning skills
- Internists and family medicine physicians seeking structured decision support
- Clinicians preparing for board certification exams requiring diagnostic reasoning
Best For
- Developing evidence-based differential diagnoses for ambiguous presenting complaints
- Justifying diagnostic test selection to supervising physicians or in medical record documentation
- Evaluating patients with multiple overlapping symptoms requiring systematic approach
- Ruling out serious diagnoses before reassurance or discharge planning
- Determining appropriate timing and urgency of specialist referrals
- Teaching diagnostic reasoning to junior clinicians or students
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