From Description to Clinical Abstraction
"Her right knee joint is swollen and painful. The joint is warm to touch and there is redness over it. She is limping and refuses to weight-bear."
"Unilateral monoarthritis involving a weight-bearing large joint."
The summary transforms a cluster of observations into a diagnostic category — opening the door to a focused differential.
"Acute febrile illness with gastrointestinal involvement and warning features."
The phrase "warning features" immediately signals the need to consider dengue, enteric fever, or severe gastroenteritis with systemic involvement. The pattern drives investigation priority — not the individual findings.
"Symptomatic anaemia."
"Symptomatic" is critical — it tells the clinician this is not an incidental finding. It demands a cause. The next step is the RAW-FACTORY-LOSS framework from Note 1 — applied to a precisely named clinical pattern.
"Thrombocytopenic mucocutaneous bleeding manifestation."
The summary points immediately to platelet disorders — ITP, dengue, leukaemia, aplastic anaemia. The negative features (no fever, no organomegaly) are already embedded in the clinician's thinking when forming the pattern, and narrow the differential further.
Reciting observations in the order they were gathered. No grouping, no interpretation, no direction. This is data collection — necessary, but not yet clinical thinking.
Recognising that findings belong together — that pallor, fatigue, and low Hb form a cluster, and that petechiae, mucosal bleeding, and low platelets form another. Grouping is the first act of pattern recognition.
Attaching a clinical label to the grouped findings. This is summarising competency. The name should describe the clinical state, not assume the diagnosis.
Using the named pattern to generate a focused, ranked differential diagnosis. The pattern determines which diagnoses are plausible — and which are not. This is where Differential Diagnosis begins.
Age immediately activates disease probability. The same pattern means different things at different ages. Nephrotic syndrome in a 3-year-old is almost certainly minimal change disease. In a 40-year-old, the differential is entirely different.
Acute vs. subacute vs. chronic changes the differential substantially. Duration is a diagnostic feature, not just background information.
Which organ system is primarily affected? This anchors the differential to the correct domain of medicine. Multi-system involvement changes the picture significantly.
The named clinical pattern — the conceptual label that replaces the list of findings. This is the heart of the summary and the hardest part to construct.
As established in Severity Assessment, it is part of the clinical picture, not an afterthought. A summary without severity descriptor does not communicate urgency. Include it when it changes the management decision.
One or two findings that are diagnostically decisive — not a repetition of all positives. Only include what actively shapes the differential.
Deliberately stated absences that narrow the differential. Only include negatives that actively exclude a significant diagnosis.
"A 7-year-old boy with a 5-day history of acute monoarthritis involving the right knee — a weight-bearing large joint — presenting with fever and inability to weight-bear, in the absence of trauma, skin rash, or prior joint disease."
A description of the clinical state in conceptual terms. It captures what the findings add up to without committing to a cause. It opens the diagnostic question.
The specific disease identified after weighing the evidence — history, examination, investigations, and response to treatment. It closes the diagnostic question with a commitment.
After clerking every patient, ask yourself this question. If you cannot express it in one or two precise sentences — you have not yet understood the case. Reorganise before you present. The summary is the lens through which everything else is seen.