17-8
A second detective story: A HEALTH PROBLEM
After discussing the steps Mama took to solve the gualamo jam mystery,
students can compare these with the steps in the diagnosis and treatment of
a health problem. This can be more fun if done as a role play with a student or
instructor pretending to be sick. For example:
A 40-year-old woman arrives complaining of severe pain in her belly. What steps
might a health worker take to figure out the cause of the pain and what to do about
it?
Following the general outline of steps Mama took in
the first detective story, the learning group tries to
diagnose the woman’s problem. The steps
they develop in this new story or role play
might be as follows:
1. Main complaint. (What bothers the
sick woman most?)
2. Doubt or uncertainty about the
cause. (Start by not knowing.)
3. An idea or guess about the
possible cause or causes.
(This idea may change as more
information is gathered.)
4. Observation of the person.
(How ill she looks, skin color,
etc.)
5. Questions (clinical history).
For example:
When did the problem begin?
Have you had it before?
What part of the belly hurts
most?
Vomiting? Appetite? Fever?
Other symptoms?
6. General physical examination
(temperature, pulse, location of
pain, etc.).
7. Consider carefully all the
possible causes that are
most likely. For example:
• gallbladder disease
• ulcer or indigestion
• hepatitis or other liver
disease
• appendicitis or gut
obstruction
• gut infection
To help consider the possible causes of this
problem, students can look at page 36 of Where
There Is No Doctor.