New grad NP and differential diagnoses

by RN623 RN623 (New) New

Specializes in Critical Care, Primary Care. Has 6 years experience.

I'm a recent new grad NP. Currently working in an under served population area in primary care. I see many patients with multiple comorbidities. I feel I am having trouble developing appropriate differential diagnoses for my patients complaints and symptoms. Particularly when the pt isn't presenting with run of the mill DM, HTN, or COPD etc. I'm wondering if others have felt the same after graduation when they were on their own. And if so what did you do to overcome this or am I being too hard on myself? I want to be right and ensure patients get the best care. Any thoughts would be appreciated.



Specializes in ICU, CV-Thoracic Sx, Internal Medicine. Has 11 years experience. 255 Posts

This is not unusual as a new provider.

I've been there, as I'm sure many others have as well.

The learning curve is different for everyone, so don't be too hard on yourself.

Best advice I can tell you is to focus on eliminating the diagnosis that are of greatest risk to your patient.

Rule out the MI, CHF exac., stroke, etc., etc.

My experience working primary care is that patients sometime will bunch up their symptoms from chronic but controlled conditions and their acute symptoms. Like a patient that shows up with c/o headaches and nausea with abdominal pain. A little digging may reveal chronic cluster headaches that have nothing to do with new onset of GI symptoms. Sounds easy to do but patients sometimes make it difficult to sort through the details. Getting to the core issues takes skill that develops over time.

Pair up with a more senior provider and run your more challenging cases with them.


2 Articles; 2,806 Posts

Are there any books in primary care with "Rule out" or differential diagnosis section for each condition?


Specializes in Adult Internal Medicine. Has 11 years experience. 3 Articles; 5,570 Posts

Are there any books in primary care with "Rule out" or differential diagnosis section for each condition?

Buttaro text is great for primary care.



727 Posts

Diagnosaurus app can help with DDx



297 Posts

5 Minute Clinical Consult is great for this and includes Diagnosaurus (but it's expensive, about $100). I'm still a student but use it at every clinical I go to. There's a separate one for peds that I'm going to get over Xmas, have that rotation coming up soon.

The best, most in-depth reference that I like to use and that allows you to look up things by symptom is UpTodDate, but that requires internet and a subscription (also pricey).

Edited to add: 5 Minute Clinical Consult is nice because it has decision trees for the most common symptoms--let's you follow an algorithm to better figure out what a patient is presenting with.