The Six Planes of Medicine

Medicine is so vast, and it can be difficult to determine how best to study it. I didn’t just think about this at the start of medical school – I constantly questioned whether my approach was optimal.

‘Traditional’ approaches to study medicine

There are two ‘traditional’ approaches:

  • Presentation-based approach – you organise your thoughts based on differentials for presenting symptoms or signs, like chest pain, breathlessness, skin rash etc.
  • Disease-based approach – you organise your thoughts by disease, for example cardiac pathology – pathologies of endocardium, myocardium, pericardium etc.

The first approach is clinically useful, and great if you want to have a list of differential diagnoses to hand. The problem is there is a lack of structure – just a flurry of symptoms and signs, so it’s easy to lose track.

The second approach is structured. It’s how most of the pathology textbooks are organised. For people who like to classify things into hierarchies (kinda like the medical maps) it’s great. The problem is patients don’t present with ‘pericardial pathology’ – they present with chest pain – so it can be tricky to marry the comprehensive classification with clinical flexibility.

Most people end up learning these two systems in parallel, and over time (several years) they become integrated together.

But is there a way to combine the clinical flexibility of the first approach with the organisation of the second?

An integrated approach – the Six Planes of Medicine

I base my studies on presenting complaints, but impose a structure. The system I use is called the Six Planes of Medicine:

six-planes_small

The Six Planes of Medicine. Five transverse planes (1-5) and one coronal plane (6) organise presenting complaints at a regional level. List of presenting complaints taking from Cambridge School of Clinical Medicine Problems and conditions list.

In the Six Planes, symptoms/signs are organised based on five transverse and one coronal plane, which anatomically localises the complaints.

In most cases, I don’t learn based on specialities (gynae/obs/paeds are exceptions, where presentations definitively ‘fit’ into that speciality alone), but the different specialities do  relate to different planes (with some overlap):

  • Plane 1: neurology, psychiatry, ophthalmology, ENT
  • Plane 2: cardiology, respiratory, gastroenterology, breast
  • Plane 3: gastroenterology, general surgery, orthopaedics (back pain)
  • Plane 4: nephrology, urology, gynaecology, obstetrics, general surgery
  • Plane 5: vascular surgery, orthopaedics, rheumatology, cardiology (leg swelling)
  • Plane 6: non-specific symptoms/signs, haematology, endocrinology, dermatology, diagnostic medicine (differentials for lab tests and imaging presentations)

Credit where credit’s due: the list of presenting complaints was obtained from a useful document Cambridge School of Clinical Medicine produce which outlines the presenting complaints medical students should be familiar with by the end of medical school.

It’s worth emphasising that these points aren’t an attribution of importance to particular specialities. It’s purely a way to think through how you approach medicine.

Medical maps and the Six Planes

For all the medical maps I post on this site, you should be able to match the map to one of these planes and one of the specific presenting complaints.

For example, plane 4: symptoms include PV bleeding, PV discharge, incontinence/prolapse etc. all of which have a medical map under gynaecology.

Ultimately what I hope is that there’ll be a medical map for all of these signs and symptoms. Although this a grand vision, provided the list of presenting complaints is comprehensive, it means the vast majority of medicine is covered in a clinically accessible, organised way.

Work in progress

The Six Planes approach can always be updated to include symptoms/signs which I have missed – contact me if there is anything else you think should be included.

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