◻ Did I obtain a comprehensive history of present illness (HPI)? Have I elicited symptom(s) onset, palliating and provoking factors, quality of symptoms, timing of symptoms (e.g. constant, intermittent), etc.?
◻ Did I obtain comprehensive past medical, surgical, psychiatric, social, family health, birth and developmental histories, including current medications, drug allergies and intolerances? Social history should include thorough trauma history since birth if possible.
◻ Did I obtain a targeted review of systems?
◻ Do I need vital signs today?
◻ Did I document a thorough mental status examination, including but not limited to: grooming, appearance, eye contact, features of speech (rate, rhythm, volume, tone, prosody, etc.), thought content, thought process, mood, affect, suicidal/violent/homicidal ideation/intent/plan, perceptual disturbances (e.g. AVH), orientation to self/time/date/place/situation, attention, concentration, insight and judgment?
◻ Do I need targeted physical examination today (e.g. cranial nerves, heart and/or lung auscultation, pulses, skin inspection, etc.)?
◻ Given all of the above information, did I construct a comprehensive differential diagnosis of all possibilities? Does my differential include psychiatric, developmental, medical, neurologic, maltreatment-related, substance-related, infectious, immunologic, rheumatologic, cardiovascular, respiratory, endocrine, gastrointestinal, renal, hematologic, oncologic, surgical, sleep-related, traumatic, gynecologic, obstetric, genetic, metabolic, environmental, and nutritional etiologies?
◻ Did I order appropriate blood and urine studies to rule out the above entities on my comprehensive differential diagnosis? Do I need head imaging? Do I need additional specialty referrals?
◻ Am I treating the most likely condition(s) based on the patient’s presentation, laboratory studies, published epidemiology, and evolving differential diagnosis?
◻ What is the strength of scientific evidence for the treatment(s) I have recommended to the patient? Do the benefits clearly outweigh the risks of the treatment(s) I recommended?
◻ To support informed consent, did I discuss risks, benefits, alternatives, etc. with the patient before initiating or changing treatment(s)? Those include effects that compromise life/limb/sight as well as drug/drug and drug/food interactions. Did the patient/guardian explicitly consent to all recommendations for evaluation and treatment?
Did I provide adequate medication supply to cover the patient until the very next appointment?
◻ Did I check appropriate surveillance studies (PDMP, bloodwork, urine studies, EKG, head imaging, etc.) for the treatment(s) I recommended? Is my recommended follow-up interval appropriate for the severity of the patient’s condition as well as expected symptom trajectory for the working [provisional] diagnosis?
◻ Did I recommend some form of psychotherapy to every patient who can actually participate?
◻ Have I revisited the differential diagnosis at every single encounter and possibly between encounters (e.g. lab results arrive asynchronously)?
◻ If one or more diagnoses require revision, what other condition(s) are best supported by the sum total of all the information I have now, including new clinical and scientific information that has emerged?
Restore psychiatry to medicine.