The 5-Finger Rule for Diagnosing Veterinary Patients

Tom Cardy, BSc, BVetMed, PhD, MRCVS, a lecturer in veterinary neurology and neurosurgery at Royal Veterinary College in London, England, explains the 5-finger rule when it comes to diagnosing a veterinary patient.

"I did some analysis on 500 dogs presenting with spinal disease to prove to my institution that a problem-based approach worked. We took a load of data from these 500 dogs on their signalmen, their clinical exam, their neurologic exam, their diagnostic tests, their imaging findings, and we did a raft of statistical analysis. And we found that actually just 5 simple variables could be associated with key spinal diseases.

And so, by taking into account the signalmen, the onset of the disease, the progression of the disease—whether it was asymmetric or symmetrical in its neurological findings—whether it was painful, and finally the neurological localization itself, we found that by using this very simple logical approach we can vastly improve the way that us as clinicians and our students were reaching a diagnosis.

The 5-finger rule as we call it, and we've typically used it as an approach to canine and feline spinal diseases, we've used it very much in-house and we found that our graduates at the Royal Veterinary College take it with them into practice and it's improved the way they're approaching their neurology cases. It's almost like learning ... If someone asks me to hit a golf ball with a golf club and just gave me a golf club, I can't do it. But if they break that down into a grip, a swing, a follow-through, it makes life much easier and that's what we're trying to do with the students. Provide them with a framework that they can use to approach these cases that gives them confidence and helps them improve their diagnosis."