MEDICAL DIAGNOSIS (abbreviated DX or DS) is the process of determining which disease or condition explains a person's symptoms and signs . It is most often referred to as DIAGNOSIS with the medical context being implicit. The information required for diagnosis is typically collected from a history and physical examination of the person seeking medical care. Often, one or more DIAGNOSTIC PROCEDURES, such as diagnostic tests , are also done during the process. Sometimes Posthumous diagnosis is considered a kind of medical diagnosis.
* 1 History * 2 Medical uses
* 3 Procedure
* 4 Adverse effects
* 4.1 Overdiagnosis * 4.2 Errors * 4.3 Lag time
* 5 Society and culture
* 5.1 Etymology * 5.2 Social context * 5.3 Concepts related to diagnosis
* 6 See also
* 6.1 Lists
* 7 References * 8 External links
Main article: History of medical diagnosis
The first recorded examples of medical diagnosis are found in the
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, but in the case of a wrong diagnosis, the individual's actual disease or condition is not the same as the individual's diagnosis.
A diagnostic procedure may be performed by various health care professionals such as a physician , physical therapist, optometrist , healthcare scientist , chiropractor , dentist , podiatrist , nurse practitioner , or physician assistant . This article uses _diagnostician_ as any of these person categories.
A diagnostic procedure (as well as the opinion reached thereby) does not necessarily involve elucidation of the etiology of the diseases or conditions of interest, that is, what _caused_ the disease or condition. Such elucidation can be useful to optimize treatment, further specify the prognosis or prevent recurrence of the disease or condition in the future.
The initial task is to detect a medical indication to perform a diagnostic procedure. Indications include:
* Detection of any deviation from what is known to be normal, such as can be described in terms of, for example, anatomy (the structure of the human body), physiology (how the body works), pathology (what can go wrong with the anatomy and physiology), psychology (thought and behavior) and 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 incidental finding of a sign unrelated to the parameter of interest, such as can occur in comprehensive tests such as radiological studies like magnetic resonance imaging or blood test panels that also include blood tests that are not relevant for the ongoing diagnosis.
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 medical history (potentially from other people close to the patient as well), physical examination and various 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. * 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 . In reality, a diagnostic procedure may involve components of multiple methods.
Main article: 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 until, aiming to reach the point where only one candidate disease or condition remains as probable. The final result may also remain a list of possible conditions, ranked in order of probability or severity.
The resultant diagnostic opinion by this method can be regarded more or less as a diagnosis of exclusion . Even if it doesn't result in a single probable disease or condition, it can at least rule out any imminently life-threatening conditions.
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.
If unexpected findings are made during this process, the initial hypothesis may be ruled out and the provider must then consider other hypotheses.
In a pattern recognition method the provider uses experience to recognize a pattern of clinical characteristics. 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.
Main article: clinical case definition
The term _diagnostic criteria_ designates the specific combination of signs , 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:
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.
OTHER DIAGNOSTIC PROCEDURE METHODS
Other methods that can be used in performing a diagnostic procedure include: An example of a medical algorithm for assessment and treatment of overweight and obesity .
* Usage of medical algorithms * An "exhaustive method", in which every possible question is asked and all possible data is collected. This is often referred to as a "diagnostic workup".
Main article: Overdiagnosis
Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. It is a problem because it turns people into patients unnecessarily and because it can lead to economic waste (overutilization ) and treatments that may cause harm. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted.
Further information: Medical error
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
Causes and factors of error in diagnosis are:
* 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
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 * _Encounter-to-diagnosis lag time_, the time from first medical encounter to diagnosis
SOCIETY AND CULTURE
The plural of diagnosis is _diagnoses._ The verb is _to diagnose,_
and a person who diagnoses is called a _diagnostician_. The word
_diagnosis_ /daɪ.əɡˈnoʊsᵻs/ is derived through
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.
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.
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.
CONCEPTS RELATED TO DIAGNOSIS
Sub-types of diagnoses include: Clinical diagnosis A diagnosis made
on the basis of medical signs and patient-reported symptoms , rather
than diagnostic tests 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 characteristics of the pathogen
Radiology diagnosis A diagnosis based primarily on the
results from medical imaging studies. Greenstick fractures are common
radiological diagnoses. 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. 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.
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 signs , 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
specificity possible, respect the presence of a condition, with the
* International Statistical Classification of
Diseases and Related Health Problems (ICD) *
* ^ See _List of medical abbreviations: D _ for variants.
* ^ "Edwin Smith Papyrus". Retrieved 2015-02-28.
* ^ H. F. J. Horstmanshoff, Marten Stol, Cornelis Tilburg (2004),
Rationality in Ancient Near Eastern and Graeco-Roman
Medicine_, p. 97-98,
Brill Publishers , ISBN 90-04-13666-5 .
* ^ Jingfeng, C. (2008). "
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