Advances in Medical Education and Practice (Jan 2025)
IMPASSIVE DICTATING: A Mnemonic Acronym for Systematically Generating Differential Diagnoses
Abstract
Maxwell Ho, Melissa Coloma,* Richard Ngo,* Jessica Santhakumar* School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA*These authors contributed equally to this workCorrespondence: Maxwell Ho, University of California, San Francisco (UCSF), 513 Parnassus Ave, Suite S221, San Francisco, CA, 94143, USA, Tel +1 415 802 9984, Email [email protected]: Systematically generating differential diagnoses facilitates a clinician’s history, physical exam, and clinical evaluation. IMPASSIVE DICTATING is an acronym for pathophysiologies to consider in a differential diagnosis: immune reactions and dysregulation, metabolic, psychiatric, allergic, structural, social, infectious, vascular, endocrine/exocrine, degenerative, iatrogenic, congenital, traumatic, autoimmune, toxic, idiopathic, neoplastic, and genetic. We suggest that this mnemonic includes several improvements on previous pathophysiology-based acronyms and have informally validated this new mnemonic with two lists of common diseases. By emphasizing mechanisms of disease rather than clinical experience, IMPASSIVE DICTATING may be particularly useful in preclinical education, other teaching contexts, and complex patient presentations. We demonstrate the use of IMPASSIVE DICTATING with several common syndromes and underscore its utility and application compared to other methods of creating differential diagnoses.Plain Language Summary: To effectively evaluate patients, clinicians generate a list of potential diagnoses based on their patients’ presentations to rule in or out. A common approach is to use an acronym for disease mechanisms that may contribute to the patient’s condition. Due to the disadvantages of currently existing mnemonic acronyms, we propose a new acronym: IMPASSIVE DICTATING, standing for immune reactions and dysregulation, metabolic, psychiatric, allergic, structural, social, infectious, vascular, endocrine/exocrine, degenerative, iatrogenic, congenital, traumatic, autoimmune, toxic, idiopathic, neoplastic, and genetic. In this paper, we discuss the use and advantages of IMPASSIVE DICTATING in different contexts, such as medical education and complex patient presentations.Keywords: differential diagnosis, medical education, pathophysiology
