Transcribed examples of statements conveying decisions according to DICTUM
| Category subgroup | Physician statement | Context | |
|---|---|---|---|
| 1 | Order test | ‘I'll get an ultrasound of it tonight’ | ER, internal medicine, deep vein thrombosis? |
| ‘There is no point in a new EEG now’ | OPC, neurologist, epilepsy | ||
| ‘You'll send in faecal tests after four, six and 8 weeks…’ | OPC, gastroenterology, Crohn's disease | ||
| ‘We'll do the A1c and some blood tests afterwards’ | OPC, endocrinology, type 2 diabetes | ||
| Consulting colleague | ‘This is a bit special so I will discuss it with a colleague’ | OPC, gastroenterology, Crohn's disease | |
| ‘I will discuss it a bit with my consultant’ | IPW, nephrology, respiratory infection? | ||
| External information | ‘We will get those images sent over and have them assessed’ | OPC, urology, kidney tumour | |
| 2 | Good | ‘140/80… I think that is very good’ | OPC, nephrology, chronic kidney disease |
| ‘I see that your A1c is 8.1, that is great’ | OPC, endocrinology, type 2 diabetes | ||
| ‘The X-ray looks fine’ | OPC, orthopaedics, hip replacement FU | ||
| ‘Everything was in perfect order; I found nothing wrong’ (after full neurological examination) | OPC, neurology, headache | ||
| Bad | ‘Your A1c was not so good’ | OPC, endocrinology, type 2 diabetes | |
| ‘You are a bit low on potassium’ | IPW, infectious disease, erysipelas | ||
| ‘Your blood pressure is high. 180/100 is high’ | OPC, cardiology, thoracic aorta graft FU | ||
| Ambiguous | ‘It wasn't too bad, but it's not great either’ (after lung auscultation) | IPW, infectious disease, pneumonia | |
| 3 | Diagnosis | ‘This is a classic case of light asthma’ | OPC, infectious disease, sinusitis and dyspnoea |
| ‘Ganglion [cyst] it is called’ | OPC, orthopaedics, lump on wrist | ||
| ‘Based on today's examination I think it is more likely that you've had a minor stroke’ | IPW, neurology, left side paresis | ||
| ‘This is basically what we call osteoarthritis’ | OPC, orthopaedics, knee pain | ||
| Aetiology | ‘I think it is paracetamol and dextropropoxyphen that has damaged your liver’ | IPW, gastroenterology, pneumonia | |
| ‘It is the torn cruciate ligament that prevents your knee from stopping where it should’ | OPC, orthopaedics, knee pain | ||
| Prognosis | ‘The chemotherapy cannot remove what you have on your lungs’ | OPC, oncology, lung metastases | |
| ‘You can profit on training up to a year after the injury’ | IPW, neurology, stroke | ||
| Evaluating state of health | ‘Your diabetes is very well regulated’ | OPC, endocrinology, type 2 diabetes | |
| ‘He's breathing nice and slowly, I think he has responded well to treatment’ | IPW, paediatrics, bronchiolitis | ||
| 4 | Start | ‘We'll start with azathioprine 50 mg’ | OPC, gastroenterology, Crohn's disease |
| ‘I was thinking you should get desloratadine, allergy pills’ | OPC, paediatrics, IBD and seasonal allergy | ||
| ‘We'll give a 4-day treatment of dexamethasone’ | IPW, paediatrics, bronchiolitis | ||
| ‘I would like you to get some vaginal oestrogen’ | OPC, gynaecology, uterine prolapse | ||
| Refrain | ‘We cannot give you chemo today’ | OPC, oncology, GI-cancer, low neutrophil count | |
| ‘You should not take ibuprofene or other blood thinners before the surgery’ | IPW, anaesthesiology, preoperative assessment | ||
| Stop | ‘It means that you can stop taking β-blockers’ | OPC, cardiology, tachyarrhythmia | |
| ‘You should cut the iron tablets’ | OPC, cardiology, chronic heart failure | ||
| Alter | ‘You'd better reduce to 50 [micrograms of levothyroxine]’ | OPC, endocrinology, Graves’ radio-iodine FU | |
| ‘Go down to two plus two [prednisolone 5 mg]” | OPC, gastroenterology, Crohn's disease | ||
| ‘You should increase the insulin detemir dosage 2 units at a time’ | OPC, endocrinology, type 2 diabetes | ||
| Maintain | ‘You should continue taking salbutamol when you need to’ | OPC, paediatrics, asthma and allergy | |
| ‘Cortisone, you'll take as earlier’ | OPC, endocrinology, Addison's disease | ||
| ‘As a foundation you should always take paracetamol 1 g 4 times a day’ | OPC, oncology, metastasised GI-cancer | ||
| 5 | Surgery | ‘It's alright to get this operated’ | OPC, gastro surgery, haemorrhoids |
| ‘We cannot operate more on you’ | OPC, orthopaedics, elbow fracture FU | ||
| Radiation | ‘And I will refer you to radiation therapy’ | OPC, haematoid-oncology, chemotherapy | |
| Interventional radiology | ‘As long as you are good we are not going to do anything now’ (angiography/PCI) | OPC, cardiology, coronary artery disease | |
| Focused care | ‘We'll take off this part of the cast so that you'll be able to bend your finger’ | OPC, orthopaedics, lower arm fracture FU | |
| ‘I think you should go a couple of weeks without the [vaginal] ring’ | OPC, gynaecology, uterine prolapse | ||
| ‘You don't have to change on the wound every day, it only irritates, let it be’ | OPC, gastro surgery, laparotomy FU | ||
| 6 | Drug refund | ‘Esomeprazole and pantoprazole are the same, pantoprazole is cheaper and the State has decided that you should drive an Opel, not a BMW’ | OPC, gastro surgery, laparotomy FU |
| ‘Owing to this [muscular stiffness on simvastatin] you qualify for atorvastatin’ | OPC, nephrology, chronic kidney disease | ||
| Sick leave | ‘You will get a sick leave note from us’ | ER, shortness of breath, admittance | |
| ‘We'll keep it like that [50% absent from work]’ | OPC, orthopaedics, leg fracture FU | ||
| ‘You will be in paid leave from work for at least 3 months’ | IPW, neurology, stroke | ||
| Disability | ‘The way you function right now you cannot drive your car’ | IPW, neurology, stroke | |
| 7 | Schedule | ‘I'll schedule a control for you here in 3 months’ | OPC, gastroenterology, Crohn's disease |
| ‘I won't schedule a new control here, seeing that you have a new appointment at the cancer centre’ | OPC, haematology-oncology, radiation | ||
| Admit | To patient's mom: ‘My suggestion is that he is admitted to the bed ward’ | OPC, thorax surgery, pneumothorax | |
| ‘I think you should spend the night in our observation ward’ | ER, internal medicine, shortness of breath | ||
| ‘She is so weak that she should be admitted’ | ER, paediatrics, vomiting | ||
| Discharge | ‘We are going to have to send you home while we wait for an opening [at the nursing home]’ | IPW, cardiology, arrhythmia, not self-sufficient | |
| ‘We thought you were going to get to go home today’ | IPW, cardiology, bleeding ulcer and heart failure | ||
| Telephone | ‘I'll call you when I get back the results’ | OPC, haematology-oncology, Waldenstrom's disease? | |
| Referral | ‘I will refer you to a neurologist’ | OPC, oncology, metastasised renal cancer | |
| ‘I'm thinking I'll send a referral to a physiotherapist’ | OPC, gynaecology, uterine prolapsed | ||
| 8 | Smoking | ‘I would recommend you to cut it completely’ | OPC, type 2 diabetes, weekend smoker |
| ‘It will require effort from you—you will have to stop smoking’ | IPW, cardiology, recent heart attack | ||
| Exercise | ‘I would recommend you to increase your level of activity’ | OPC, endocrinology, type 2 diabetes | |
| ‘I would stay away from soccer’ | OPC, orthopaedics, ACL rupture pending surgery | ||
| Diet | ‘Mind the calories; sweetened beverages, potato chips, cakes, sauces…’ | OPC, gastro surgery, rectal cancer FU | |
| Weight | ‘The weight increase should not continue, then you'll have crossed a line’ | OPC, nephrology, chronic kidney disease | |
| Hydration | To boy's mom: ‘He should get at least 3–4 glasses [to drink] per day’ | IPW, paediatrics, gastroenteritis | |
| ‘Be careful to drink a lot of water’ | OPC, gastro surgery, sigmoidostomy | ||
| Alcohol | ‘Together with warfarin, it's not advisable to drink alcohol’ | IPW, cardiology, right-sided heart failure | |
| Mobilisation | ‘Be careful with sudden movements and heavy lifting’ | IPW, cardiology, recent coronary bypass | |
| ‘Avoid activity that you notice makes this worse’ | OPC, neurology, neck pain, numbness in arm | ||
| ‘Mind keeping the leg high while you are sitting’ | OPC, orthopaedics, leg fracture FU | ||
| Sleep | ‘Staying up late lowers the threshold for cramps’ | OPC, neurology, epilepsy | |
| Precaution | ‘If you were to get a fever, you have to contact a doctor’ | OPC, gastroenterology, Crohn's disease | |
| ‘If you start bleeding heavily [from your bowels], you have to contact the hospital’ | OPC, gastroenterology, ulcerous colitis | ||
| ‘However, if it gets more painful in the chest or something like that, you'll take contact’ | OPC, cardiology, coronary artery disease | ||
| ‘If it doesn't get better, call 911’ | OPC, cardiology, coronary artery disease | ||
| 9 | Quantitative | ‘The goal has to be that it should be 120/80’ | OPC, type 2 diabetes, BP 135/80 |
| ‘We want to get the A1c down between 7 and 8’ | OPC, type 2 diabetes, A1c 9,2 | ||
| ‘I would like to see your viral counts under 50’ | OPC, infectious disease, HIV, viral count 700 | ||
| Qualitative | ‘What you should work on the next year is building your strength’ | OPC, orthopaedics, knee prosthesis FU | |
| ‘Seeing that this is a curative setting I don't dare to lower your dose’ | OPC, oncology, GI-cancer | ||
| ‘The goal has to be to get as good as you were before’ | IPW, neurology, stroke | ||
| 10 | Transfer responsibility | ‘I don't know for sure, but they know all about it at the cancer centre’ | OPC, haematology-oncology, radiation |
| ‘The issue of your driver's license, you have to discuss with your family doctor’ | IPW, cardiology, chronic heart failure | ||
| Change subject | Patient asks about prescription for sildenafil—physician changes topic | OPC, infectious disease, HIV | |
| Wait and see | ‘We'll see how it goes’ | IPW, gastroenterology, abdominal pain | |
| ‘I would like to wait and see [with regards to implantation of grommets]’ | OPC, ear-nose-throat, fluid in ear | ||
| ‘I think we'll wait and see for 4 weeks’ | OPC, neurology, neck pain, numbness in arm | ||
| Active and specified | ‘I'll have to think about this [choice between sunitinib and interferon treatment]’ | OPC, oncology, metastasised renal cancer |
ACL, anterior cruciate ligament; A1c, glycated haemoglobin; BP, blood pressure; ER, emergency room; FU, follow-up; GI, gastrointestinal; IBD, inflammatory bowel disease; IPW, inpatient ward; OPC, outpatient; PCI, percutaneous coronary intervention.