Wheeland Spoke Formulation of the Crisis

The wheel-and-spoke format is a useful tool to help develop a formulation that specifies the causes of the crisis and can assist in the development of an effective, prioritized treatment plan. The acute crisis should be pictured as the center of a wheel. The spokes of the wheel are the problems or symptoms that are likely causing or contributing to the crisis. The physician can establish a numbered priority list for problem solving. For each problem listed, the family physician recommends a specific evaluation, test, or treatment approach designed to ameliorate the crisis. An application of the wheel-and-spoke diagram for Denise's case is illustrated in Figure 45-4.

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