Medical diagnosis (abbreviatedDx,[1]Dx, orDs) is the process of determining whichdisease or condition explains a person'ssymptoms andsigns. It is most often referred to as adiagnosis with themedical context being implicit. The information required for a diagnosis is typically collected from ahistory andphysical examination of the person seeking medical care. Often, one or morediagnostic procedures, such asmedical tests, are also done during the process. Sometimes theposthumous diagnosis is considered a kind of medical diagnosis.
Diagnosis is often challenging because many signs and symptoms arenonspecific. For example, redness of theskin (erythema), by itself, is a sign of many disorders and thus does not tell the healthcare professional what is wrong. Thusdifferential diagnosis, in which several possible explanations are compared and contrasted, must be performed. This involves thecorrelation 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 ispathognomonic.[citation needed]
Diagnosis is a major component of theprocedure of a doctor's visit. From the point of view ofstatistics, the diagnostic procedure involvesclassification tests.
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 varioushealthcare professionals such as aphysician,physiotherapist,dentist,podiatrist,optometrist,nurse practitioner,healthcare scientist orphysician assistant. This article usesdiagnostician as any of these person categories.[citation needed]
A diagnostic procedure (as well as the opinion reached thereby) does not necessarily involve elucidation of theetiology of the diseases or conditions of interest, that is, whatcaused 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.[citation needed]
The initial task is to detect amedical indication to perform a diagnostic procedure. Indications include:[citation needed]
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 anincidental finding of a sign unrelated to the parameter of interest, such as can occur in comprehensive tests such asradiological studies likemagnetic resonance imaging orblood 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:
There are a number of methods or techniques that can be used in a diagnostic procedure, including performing adifferential diagnosis or followingmedical algorithms.[4]: 198 In reality, a diagnostic procedure may involve components of multiple methods.[4]: 204
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 aprocess of elimination or at least of rendering the entries more or less probable by furthermedical 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 adiagnosis 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 initialhypothesis may be ruled out and the provider must then consider other hypotheses.[citation needed]
In apattern 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 beingassociated 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]
The termdiagnostic criteria designates the specific combination ofsigns and symptoms, and test results that theclinician uses to attempt to determine the correct diagnosis.
Some examples of diagnostic criteria, also known asclinical case definitions, are:
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 methods that can be used in performing a diagnostic procedure include:
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 is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime.[9] It is a problem because it turns people into patients unnecessarily and because it can lead to economic waste[10] (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.[11]
Most people will experience at least one diagnostic error in their lifetime, according to a 2015 report by theNational Academies of Sciences, Engineering, and Medicine.[12]
Causes and factors of error in diagnosis are:[13]
When making a medical diagnosis, a lag time is a delay in time until a step towardsdiagnosis of a disease or condition is made. Types of lag times are mainly:
Long lag times are often called "diagnostic odyssey".
The first recorded examples of medical diagnosis are found in the writings ofImhotep (2630–2611 BC) inancient Egypt (theEdwin Smith Papyrus).[16] ABabylonian medical textbook, theDiagnostic Handbook written byEsagil-kin-apli (fl.1069–1046 BC), introduced the use ofempiricism,logic andrationality in the diagnosis of an illness ordisease.[17]Traditional Chinese Medicine, as described in the Yellow Emperor's Inner Canon orHuangdi Neijing, specified four diagnostic methods: inspection, auscultation-olfaction, inquiry andpalpation.[18]Hippocrates was known to make diagnoses by tasting his patients' urine and smelling their sweat.[19]
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 isdiagnoses. The verb isto diagnose,and a person who diagnoses is called adiagnostician.
The worddiagnosis/daɪ.əɡˈnoʊsɪs/ is derived throughLatin from theGreek word διάγνωσις (diágnōsis) from διαγιγνώσκειν (diagignṓskein), meaning "to discern, distinguish".[20]
Diagnosis can take many forms.[21] It might be a matter of naming the disease, lesion, dysfunction or disability. It might be a management-naming or prognosis-naming exercise. It may indicate either degree of abnormality on a continuum or kind of abnormality in a classification. It is influenced by non-medical factors such as power, ethics and financial incentives for patient or doctor. It can be a brief summation or an extensive formulation, even taking the form of a story or metaphor. It might be a means of communication such as a computer code through which it triggers payment, prescription, notification, information or advice. It might bepathogenic orsalutogenic. It is generally uncertain and provisional.
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 theetiology, 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 tomonitor 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 themedical 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:
Sub-types of diagnoses include:
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