Why is Diagnosis Important? Accurate diagnosis precedes the three tasks central to the healing professions: explanation, prognostication, and therapy. These three tasks have been consistently performed by physicians throughout time and across cultures, regardless of the belief system or theory underpinning the practice: magic, faith, rationalism, or science. Remembering the real questions.
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Why is Diagnosis Important? Accurate diagnosis precedes the three tasks central to the healing professions: explanation, prognostication, and therapy. These three tasks have been consistently performed by physicians throughout time and across cultures, regardless of the belief system or theory underpinning the practice: magic, faith, rationalism, or science. Remembering the real questions. Ann Intern Med. J Gen Intern Med. On the other hand, for many complaints, in otherwise healthy people with no alarm symptoms or signs, a good prognosis can be ascertained without knowing the exact cause of the complaint, as, for instance, an upper respiratory infection.
The experienced clinician can reassure the patient that further testing is unnecessary and will not change prognosis or treatment. It takes experience, knowledge of the medical literature, good judgment, and an understanding of the fundamentals of clinical epidemiology and decision making to determine when pursuit of specific symptoms and signs is warranted.
For an excellent review of the principles of epidemiology in a highly readable format, see Fletcher et al. Clinical Epidemiology, the Essentials. Each pattern receives a specific name. When a common etiology and pathophysiology are confirmed, we designate the condition a disease. Other clusters of attributes, known by a combination of features not clearly related to a single cause, are called syndromes. Diseases and syndromes are intellectual constructs allowing the physicians to study groups of patients with relatively homogeneous physiologic disorders; they do not exist independently of the patients who manifest them.
The diagnosis of a disease or syndrome provides an entry to the medical literature to obtain information about etiology, diagnostic findings, treatment, and prognosis.
Every disease has a temporal sequence of clinical
DeGowin & DeGowin's Diagnostic Examination
This was true for Hippocrates and Osler and remains true today. The practice of medicine would be simple if each symptomor sign indicated a single disease. There are enormous numbers of symptoms and signs we cover several hundred and they can occur in a nearly infinite number of combinations and temporal patterns. These symptoms and signs are the rough fibers from which the clinician must weave a clinical narrative, anatomically and pathophysiologically explicit, forming the diagnostic hypotheses. To master the diagnostic process, a clinician must have four essential attributes: Knowledge: Familiarity with the pathophysiology, symptoms, and signs of common and unusual diseases. Skill: The ability to take an accurate and complete history and perform an appropriate physical examination to elicit the pattern of symptoms and signs from each patient. Judgment: Knowledge of medical science and the medical literature combined with experience reflected upon hones the judgment necessary to know when and how to test these hypotheses with appropriate laboratory tests or clinical interventions [Reilly BM.
DeGowin’s Diagnostic Examination 10th Edition PDF
The tests discussed are commonly used to formulate physiologic and diagnostic hypotheses. The much more numerous, specific tests used for confirming the diagnosis of a specific disease should not be used until a narrow differential diagnosis has been established. These more specific tests are not discussed here. Common examples include testing for hemochromatosis with iron studies and lipids for hypercholesterolemia. Case finding. Some tests are used to identify affected symptomatic individuals within specific at-risk populations. This differs from screening because a specific high-risk population, rather than the general population, has been selected for testing.