Medical diagnosis
Medical diagnosis (abbreviated Dx,
Diagnosis is often challenging because many signs and symptoms are nonspecific. For example, redness of the skin (erythema), by itself, is a sign of many disorders and thus does not tell the healthcare professional what is wrong. Thus differential diagnosis, in which several possible explanations are compared and contrasted, must be performed. This involves the correlation of various pieces of information followed by the recognition and differentiation of patterns. Occasionally the process is made easy by a sign or symptom (or a group of several) that is pathognomonic.[citation needed]
Diagnosis is a major component of the
Medical uses
A diagnosis, in the sense of diagnostic procedure, can be regarded as an attempt at classification of an individual's condition into separate and distinct categories that allow medical decisions about treatment and prognosis to be made. Subsequently, a diagnostic opinion is often described in terms of a disease or other condition. (In the case of a wrong diagnosis, however, the individual's actual disease or condition is not the same as the individual's diagnosis.) A total evaluation of a condition is often termed a diagnostic workup.[2]
A diagnostic procedure may be performed by various
A diagnostic procedure (as well as the opinion reached thereby) does not necessarily involve elucidation of the
The initial task is to detect a medical indication to perform a diagnostic procedure. Indications include:[citation needed]
- Detection of any deviation from what is known to be normal, such as can be described in terms of, for example, human homeostasis(regarding mechanisms to keep body systems in balance). Knowledge of what is normal and measuring of the patient's current condition against those norms can assist in determining the patient's particular departure from homeostasis and the degree of departure, which in turn can assist in quantifying the indication for further diagnostic processing.
- A complaint expressed by a patient.
- The fact that a patient has sought a diagnostician can itself be an indication to perform a diagnostic procedure. For example, in a doctor's visit, the physician may already start performing a diagnostic procedure by watching the gait of the patient from the waiting room to the doctor's office even before she or he has started to present any complaints.
Even during an already ongoing diagnostic procedure, there can be an indication to perform another, separate, diagnostic procedure for another, potentially concomitant, disease or condition. This may occur as a result of an
Procedure
General components which are present in a diagnostic procedure in most of the various available methods include:
- Complementing the already given information with further data gathering, which may include questions of the diagnostic tests.
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. Diagnostic tests can also be used to provide prognostic information on people with established disease.[3] - Processing of the answers, findings or other results. Consultations with other providers and specialists in the field may be sought.
There are a number of methods or techniques that can be used in a diagnostic procedure, including performing a differential diagnosis or following medical algorithms.[4]: 198 In reality, a diagnostic procedure may involve components of multiple methods.[4]: 204
Differential diagnosis
The method of differential diagnosis is based on finding as many candidate diseases or conditions as possible that can possibly cause the signs or symptoms, followed by a process of elimination or at least of rendering the entries more or less probable by further medical tests and other processing, aiming to reach the point where only one candidate disease or condition remains as probable. The result may also remain a list of possible conditions, ranked in order of probability or severity. Such a list is often generated by computer-aided diagnosis systems.[5]
The resultant diagnostic opinion by this method can be regarded more or less as a diagnosis of exclusion. Even if it does not result in a single probable disease or condition, it can at least rule out any imminently life-threatening conditions.[citation needed]
Unless the provider is certain of the condition present, further medical tests, such as medical imaging, are performed or scheduled in part to confirm or disprove the diagnosis but also to document the patient's status and keep the patient's medical history up to date.[citation needed]
If unexpected findings are made during this process, the initial hypothesis may be ruled out and the provider must then consider other hypotheses.[citation needed]
Pattern recognition
In a pattern recognition method the provider uses experience to recognize a pattern of clinical characteristics.[4]: 198, [6] It is mainly based on certain symptoms or signs being associated with certain diseases or conditions, not necessarily involving the more cognitive processing involved in a differential diagnosis.
This may be the primary method used in cases where diseases are "obvious", or the provider's experience may enable him or her to recognize the condition quickly. Theoretically, a certain pattern of signs or symptoms can be directly associated with a certain therapy, even without a definite decision regarding what is the actual disease, but such a compromise carries a substantial risk of missing a diagnosis which actually has a different therapy so it may be limited to cases where no diagnosis can be made.[citation needed]
Diagnostic criteria
The term diagnostic criteria designates the specific combination of signs and symptoms, and test results that the clinician uses to attempt to determine the correct diagnosis.
Some examples of diagnostic criteria, also known as clinical case definitions, are:
- Amsterdam criteria for hereditary nonpolyposis colorectal cancer
- McDonald criteria for multiple sclerosis
- ACR criteria for systemic lupus erythematosus
- Centor criteria for strep throat
Clinical decision support system
Clinical decision support systems are interactive computer programs designed to assist health professionals with decision-making tasks. The clinician interacts with the software utilizing both the clinician's knowledge and the software to make a better analysis of the patients data than either human or software could make on their own. Typically the system makes suggestions for the clinician to look through and the clinician picks useful information and removes erroneous suggestions.[7] Some programs attempt to do this by replacing the clinician, such as reading the output of a heart monitor. Such automated processes are usually deemed a "device" by the FDA and require regulatory approval. In contrast, clinical decision support systems that "support" but do not replace the clinician are deemed to be "Augmented Intelligence" if it meets the FDA criteria that (1) it reveals the underlying data, (2) reveals the underlying logic, and (3) leaves the clinician in charge to shape and make the decision.[citation needed]
Other diagnostic procedure methods
Other methods that can be used in performing a diagnostic procedure include:
- Usage of medical algorithms
- An "exhaustive method", in which every possible question is asked and all possible data is collected.[4]: 198
Adverse effects
Diagnosis problems are the dominant cause of medical malpractice payments, accounting for 35% of total payments in a study of 25 years of data and 350,000 claims.[8]
Overdiagnosis
Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime.
Errors
Most people will experience at least one diagnostic error in their lifetime, according to a 2015 report by the National Academies of Sciences, Engineering, and Medicine.[12]
Causes and factors of error in diagnosis are:[13]
- the manifestation of disease are not sufficiently noticeable
- a disease is omitted from consideration
- too much significance is given to some aspect of the diagnosis
- the condition is a rare disease with symptoms suggestive of many other conditions
- the condition has a rare presentation
Lag time
When making a medical diagnosis, a lag time is a delay in time until a step towards diagnosis of a disease or condition is made. Types of lag times are mainly:
- Onset-to-medical encounter lag time, the time from onset of symptoms until visiting a health care provider[14]
- Encounter-to-diagnosis lag time, the time from first medical encounter to diagnosis[14]
- Lag time due to delays in reading x-rays have been cited as a major challenge in care delivery. The Department of Health and Human Services has reportedly found that interpretation of x-rays is rarely available to emergency room physicians prior to patient discharge.[15]
Long lag times are often called "diagnostic odyssey".
History
The first recorded examples of medical diagnosis are found in the writings of
Word
Medical diagnosis or the actual process of making a diagnosis is a cognitive process. A clinician uses several sources of data and puts the pieces of the puzzle together to make a diagnostic impression. The initial diagnostic impression can be a broad term describing a category of diseases instead of a specific disease or condition. After the initial diagnostic impression, the clinician obtains follow up tests and procedures to get more data to support or reject the original diagnosis and will attempt to narrow it down to a more specific level. Diagnostic procedures are the specific tools that the clinicians use to narrow the diagnostic possibilities.
The plural of diagnosis is diagnoses. The verb is to diagnose, and a person who diagnoses is called a diagnostician.
Etymology
The word diagnosis /daɪ.əɡˈnoʊsɪs/ is derived through Latin from the Greek word διάγνωσις (diágnōsis) from διαγιγνώσκειν (diagignṓskein), meaning "to discern, distinguish".[20]
Society and culture
Social context
Diagnosis can take many forms.
Once a diagnostic opinion has been reached, the provider is able to propose a management plan, which will include treatment as well as plans for follow-up. From this point on, in addition to treating the patient's condition, the provider can educate the patient about the etiology, progression, prognosis, other outcomes, and possible treatments of her or his ailments, as well as providing advice for maintaining health.[citation needed]
A treatment plan is proposed which may include therapy and follow-up consultations and tests to monitor the condition and the progress of the treatment, if needed, usually according to the medical guidelines provided by the medical field on the treatment of the particular illness.[citation needed]
Relevant information should be added to the medical record of the patient.
A failure to respond to treatments that would normally work may indicate a need for review of the diagnosis.
Nancy McWilliams identifies five reasons that determine the necessity for diagnosis:
- diagnosis for treatment planning;
- information contained in it related to prognosis;
- protecting interests of patients;
- a diagnosis might help the therapist to empathize with his patient;
- might reduce the likelihood that some fearful patients will go-by the treatment.[22]
Types
Sub-types of diagnoses include:
- Clinical diagnosis
- A diagnosis made on the basis of diagnostic tests[citation needed]
- Laboratory diagnosis
- A diagnosis based significantly on laboratory reports or test results, rather than the physical examination of the patient. For instance, a proper diagnosis of infectious diseases usually requires both an examination of signs and symptoms, as well as laboratory test results and characteristics of the pathogen involved.[citation needed]
- Radiology diagnosis
- A diagnosis based primarily on the results from medical imaging studies. Greenstick fractures are common radiological diagnoses.[citation needed]
- Electrography diagnosis
- A diagnosis based on measurement and recording of electrophysiologic activity.[citation needed]
- Endoscopy diagnosis
- A diagnosis based on endoscopic inspection and observation of the interior of a hollow organ or cavity of the body.[citation needed]
- Tissue diagnosis
- A diagnosis based on the macroscopic, microscopic, and molecular examination of tissues such as biopsies or whole organs. For example, a definitive diagnosis of pathologist.[citation needed]
- Principal diagnosis
- The single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment. Many patients have additional diagnoses.[citation needed]
- Admitting diagnosis
- The diagnosis given as the reason why the patient was admitted to the hospital; it may differ from the actual problem or from the discharge diagnoses, which are the diagnoses recorded when the patient is discharged from the hospital.[23]
- Differential diagnosis
- A process of identifying all of the possible diagnoses that could be connected to the signs, symptoms, and lab findings, and then ruling out diagnoses until a final determination can be made.
- Diagnostic criteria
- Designates the combination of symptoms, and test results that the clinician uses to attempt to determine the correct diagnosis. They are standards, normally published by international committees, and they are designed to offer the best sensitivity and specificitypossible, respect the presence of a condition, with the state-of-the-art technology.
- Prenatal diagnosis
- Diagnosis work done before birth
- Diagnosis of exclusion
- A medical condition whose presence cannot be established with complete confidence from history, examination or testing. Diagnosis is therefore by elimination of all other reasonable possibilities.
- Dual diagnosis
- The diagnosis of two related, but separate, medical conditions or comorbidities. The term almost always referred to a diagnosis of a serious mental illness and a substance use disorder, however, the increasing prevalence of genetic testing has revealed many cases of patients with multiple concomitant genetic disorders.[5]
- Self-diagnosis
- The diagnosis or identification of a medical conditions in oneself. Self-diagnosis is very common.
- Remote diagnosis
- A type of telemedicinethat diagnoses a patient without being physically in the same room as the patient.
- Nursing diagnosis
- Rather than focusing on biological processes, a nursing diagnosis identifies people's responses to situations in their lives, such as a readiness to change or a willingness to accept assistance.
- Computer-aided diagnosis
- Providing
- Overdiagnosis
- The diagnosis of "disease" that will never cause symptoms, distress, or death during a patient's lifetime
- Wastebasket diagnosis
- A vague, or even completely fake, medical or psychiatric label given to the patient or to the overmedicalization, such as the labeling of normal responses to physical hunger as reactive hypoglycemia.
- Retrospective diagnosis
- The labeling of an illness in a historical figure or specific historical event using modern knowledge, methods and disease classifications.
See also
- Diagnosis codes
- Diagnosis-related group
- Diagnostic and Statistical Manual of Mental Disorders
- Doctor-patient relationship
- Etiology (medicine)
- International Statistical Classification of
Diseases and Related Health Problems (ICD) - Medical classification
- Merck Manual of Diagnosis and Therapy
- Medical error
- Nosology
- Nursing diagnosis
- Pathogenesis
- Pathology
- Prediction
- Preimplantation genetic diagnosis
- Prognosis
- Sign (medicine)
- Symptom
Lists
- List of diagnostic classification and rating scales used in psychiatry
- List of diseases
- List of disorders
- List of medical symptoms
- Category:Diseases
References
- ^ See List of medical abbreviations: D for variants.
- ^ "Definition of workup". www.merriam-webster.com. Retrieved 30 January 2024.
- ^ Thompson, C. & Dowding, C. (2009) Essential Decision Making and Clinical Judgement for Nurses.
- ^ ISBN 0-306-46692-9.
- ^ S2CID 53758271.
- PMID 34300440.
- ^ Decision support systems. 26 July 2005. 17 Feb. 2009 <http://www.openclinical.org/dss.html Archived 2020-02-02 at the Wayback Machine>
- ^ "Diagnostic errors are leading cause of successful malpractice claims". The Washington Post. 2012-04-30. Archived from the original on 2018-12-05. Retrieved 2016-10-31.
- ^ What is overdiagnosis?. Institute for Quality and Efficiency in Health Care (IQWiG). 20 April 2017.
- S2CID 10441386.
- ^ Gawande, Atul (4 May 2015). "America's Epidemic of Unnecessary Care". The New Yorker.
- .
- ^ PMID 8003053.
- ^ Office of Health and Human Services: Office of Inspector General (1993). "Medicare's Reimbursement for Interpretations of Hospital Emergency Room X-Rays" (PDF). Department of Health and Human Services Office of Inspector General.
- ^ "Edwin Smith Papyrus". Retrieved 2015-02-28.
- ISBN 90-04-13666-5.
- ISBN 978-1-4020-4559-2.
- ^ "What Would Hipocrates Do?". 23 September 2008. Retrieved February 28, 2015.
- ^ "Online Etymology Dictionary".
- ISBN 978-1-84619-477-1.
- ISBN 978-1-60918-494-0.
- ^ "admitting diagnosis". The Free Dictionary.
- PMID 8190157.
- ^ WebMed Solutions. "Connection between onset of symptoms and diagnosis". Archived from the original on 13 February 2019. Retrieved 15 January 2012.
External links
- Media related to Medical diagnosis at Wikimedia Commons