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What Is the Surgical Sieve?

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  • Written By: Mary McMahon
  • Edited By: Kristen Osborne
  • Last Modified Date: 18 April 2014
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The surgical sieve is a framework medical practitioners can use during diagnosis and evaluation to quickly run through possible causes of a medical complaint, covering as many as possible, so they can reach a diagnosis. While sifting through potential causes, doctors can come up with more questions for patients so they can rule various options in or out. They may also think of medical tests they can use to further the diagnostic process.

With the surgical sieve, the doctor considers the symptoms and available information about the patient's condition, and comes up with a list of all possible causes of those symptoms, running through different anatomical systems to make sure everything is covered. The doctor considers congenital and acquired explanations, as well as neoplastic, traumatic, vascular, neurological, and other causes of disease to start hypothesizing about why the patient feels ill.

Many doctors use a mnemonic to help them remember all the body systems they want to cover, to make sure they don't miss anything. For example, VITAMIN covers vascular, inflammatory or infective, traumatic, autoimmune, metabolic, iatrogenic or idiopathic, and neoplastic causes of disease. Doctors working in teaching hospitals can use the surgical sieve to prompt their interns and residents, structuring questions to get them thinking about diagnostic techniques and practices.

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As a doctor works through the surgical sieve, some potential diagnoses may be struck down immediately; for example, a doctor would come up with a vascular cause, but note that a patient lacks another symptom necessary for diagnosis with that condition. The doctor should develop a list of working potential explanations and can query the patient to check on other symptoms while also running tests to see if any potential candidates are a good fit. The goal is to narrow down the options to one, so the doctor can offer a diagnosis and start discussing treatment options.

While in medical school, people may learn a specific mnemonic from a mentor, and will often use that during clinical practice. Other people invent their own to help themselves remember. One issue with the surgical sieve is the need for flexibility. People need to be able to adjust their answers as new symptoms emerge, and must consider the fact that they are on the wrong track from the start; something people think is a symptom may be an unrelated medical issue, for instance, complicating diagnosis by tricking people into thinking it is caused by the primary condition.

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Discuss this Article

MrMoody
Post 3

@Charred - Doctors do a good job, generally. The surgical sieve is basically a process of elimination. As your doctor sits there jotting notes as you answer his questions, he is practicing deduction to narrow the list of possible problems you may be dealing with.

The biggest problem that doctors deal with, honestly, is this thing called the Internet. Anyone can go online and “diagnose” themselves.

Soon the patient comes in and he thinks he knows what the diagnosis is, based on having answered a few questions in a web survey – and if they’re brave, they tell the doctor.

That just irritates them. I know, because I’ve irritated them myself. I recommend that even if you think that you know what the problem is, let the doctor make the final determination.

Charred
Post 2

@David09 - Doctors are often not trained in nutrition unfortunately. But it reinforces a basic point. You need to become your own health advocate in that sense of the term. Still, however, doctors do a pretty good job when they run through their checklist.

I went to a doctor and complained about breathing problems. I said I thought it was heart related and he challenged me right away. I guess I was just thinking out of fear, but he said we would first run some tests on my lungs first and then gradually rule out other things.

So I have a test scheduled in the next few weeks to see how my lungs are doing. That seems to make sense. I am glad that the doctor challenged me, however, because I was planning to go get a battery of heart tests, just on the basis of my own diagnosis.

David09
Post 1

I respect the knowledge that doctors have, but unfortunately they sometimes come to the wrong conclusions. For example, I used to have this muscular twitching condition for many years.

Muscles in my body and legs would just twitch. I didn’t know whether it was nerves or what it was. I went to a doctor and within fifteen minutes he thought I had some psychological problem and said I needed to see a psychiatrist!

I was offended that this guy thought I was mentally unstable. This was clearly a physical condition, not something that I was imagining and it wasn't (in my opinion) psychosomatic.

Well, I ignored his advice. It wasn't until years later that I went to see a nutritionist, and she told me it was the result of mineral deficiency. She told me to load up on vegetables every day, morning, noon and night. I did that, and the problem went away.

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