As a beginner in hospital clinical medicine, my initial struggle, besides perpetually low caffeine levels, was trying to get a handle on the seemingly vast comprehensiveness of the management plan needed to cover all aspects of care from admission to discharge in a timely manner. It often got overwhelming and made me feel nervous, unorganized & unsatisfied. I came up with a mental framework to help tame that comprehensiveness to more manageable, analytical chunks of thought processing – no matter what the clinical issue is.
Here’s the 6-Cs Clinical framework which might benefit other beginners:
Cure : What is the cure for the condition ?
Contain or Control Damage: If no cure or awaiting cure, what can be done to contain further damage?
Complications control: prevent or treat any direct complications of the condition
Cause determination: What Labs/Imaging/Procedures are needed to identify a direct cause ?
Contributors : What Labs/Imaging/Procedures can identify contributors (or risk factors) to treat?
Curb recurrence risk: What Interventions can you do to curb or cut risk of this re-happening?
A beautiful example for the framework is ischemic stroke management
Cure? : Eligible for tPA or endovascular intervention. Too late for that? then focus on controlling the damage
Contain / Control damage: avoid fevers, hyperglycemia, and uncontrolled BP to preserve penumbra, improve recovery
Complications to prevent/treat? : Aspiration (keep NPO, have speech pathology see), pressure sores, fall risk (consult PT/OT), Depression, DVT
Cause analysis: ECHO, EKG, Carotid Duplex, etc (Cardiac Clots, AFib Carotid stenosis, PFO)
Contributors: A1c, Lipid Panel check, if any uncontrolled HTN history, sleep apnea, etc
Curb recurrence risk: Secondary prevention with ASA/Plavix/Anticoagulation along with BP/DM/Cholesterol control
Let’s take something surgical such as a Fracture:
Cure = surgical fixation – consult orthopedics, do a quick pre-op eval
Control damage: immobilize the fracture area with a splint while awaiting surgery since movement & weight bearing can worsen it
Complications to prevent/treat: Blood loss anemia? Pain? compartment syndrome?
Cause: trauma? Fall? Syncope? (Fall: Vit D def. , Neuropathy, Alcoholism, orthostatic )
Contributors: Osteoporosis? Vit D. deficiency ? / Neuropathy causing falls? – B12/Folate/Alcoholism.
Curb recurrence risk: Rehab, address Osteoporosis, address malnutrition
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