A differential diagnosis is a complete list of diseases of one person, the presence of which was proved by the results of all the necessary research methods. This conclusion suggests a hierarchical arrangement of diseases from the most significant to the least important at the moment.
Practical benefit
For the attending physician, making a differential diagnosis is an extremely important task. Only after it is formed does the doctor have the opportunity to most effectively influence those pathological processes that occur inside the patient’s body.
A differential diagnosis is necessary at each treatment of the patient. It does not matter if the person is in the hospital or is undergoing treatment at the outpatient stage.
Statement technique
To form a full-fledged diagnosis, proved by all the necessary research methods, is a rather difficult task. It is especially difficult for young and not very experienced medical workers. In order to facilitate this task, there is a "gold standard" for the formation of a differential diagnosis. This technique includes the following steps:
- Identification of syndromes present in patients.
- Isolation of the main pathology from them.
- Formation of a list of diseases for which the presence of identified syndromes is characteristic, adjusted for the possibility of developing these diseases in a particular patient
- Appointment of an additional examination.
- Direct formation of a list of identified diseases according to a hierarchical basis.
Thanks to the use of this technique, it is much easier and faster to make a differential diagnosis.
The basic principles of formation
There are several fundamental rules that make it much easier to make a differential diagnosis. Syndromes and symptoms identified in the patient will become the main tools that the doctor will work with. The main principles for the formation of such a conclusion are as follows:
- significant differences;
- exception through the opposite;
- compiling a differential table.
The principle of significant difference eliminates the majority of diseases. During its use, the doctor removes from the list of possible pathologies all diseases for which the development of the patient's symptoms and syndromes is uncharacteristic.
The principle of exclusion through the opposite allows you to narrow the range of possible diseases due to those of them, the presence of which is impossible with the clinical picture observed in the patient and according to laboratory and instrumental studies.
Drawing up a differential table allows you to complete the formation of the diagnosis. Thanks to her, the doctor gets the opportunity to isolate a specific disease, the presence of which is most likely according to all available data. Naturally, there is a certain degree of inaccuracy when using this method even in cases where the patient has undergone the most complex and modern medical research. The differential diagnosis may be somewhat adjusted during treatment and patient monitoring.
Example
For a more detailed consideration of the formation of such a conclusion, a specific example should be considered. The patient has the following symptoms:
- severe pain sensations of a burning nature in the epigastric region immediately after a meal;
- decreased appetite, nausea, weight loss;
- hypochromic anemia.
All these symptoms make any doctor think, first of all, about the patient’s presence of malignant diseases of the stomach. Moreover, in the process of collecting an anamnesis, it was revealed that the patient does not have these manifestations for the first time. Constant exacerbations are observed with the development of the indicated symptoms twice a year - in spring and autumn. Having received this additional information, the doctor is already inclined to the diagnosis of gastric ulcer, however, neither malignant neoplasm of the stomach, nor gastritis can be ruled out either.
To make a differential diagnosis of chronic gastric ulcer, an additional examination is necessary. To clarify the disease, you will need:
- Esophagogastroduodenoscopy with biopsy (sampling of a portion of damaged tissue of the gastric mucosa).
- Biochemical blood test (AlAT, AsAT, bilirubin).
- Histological examination of the damaged tissue of the gastric mucosa (biopsy specimen obtained as a result of EFGDS).
When conducting esophagogastroduodenoscopy in a patient, ulceration of the gastric mucosa is detected. As a result, the doctor can exclude gastritis, since this disease is characterized by hyperemia of the gastric mucosa without the development of ulcerative lesions. As for malignant neoplasms, in this patient such a diagnosis can be excluded only after a histological examination of the biopsy specimen in the absence of cancer cells in its structure.
Relationship between differential diagnosis and treatment
In many situations, the patient’s condition does not allow us to expect the full range of studies to prescribe certain drugs. This is especially true when the doctor tries to establish a differential diagnosis of acute illness. In these cases, the doctor prescribes empirical treatment to the patient, resorting to the use of only those drugs that do not exactly harm.
Often, such therapy not only improves the patient's condition, but also becomes part of the differential diagnosis.
Differences between inpatient and outpatient care
The provision of medical care during hospitalization is aimed at maximizing patient recovery. It is for this reason that doctors working in a hospital have a slightly lower burden than those who work in outpatient facilities.
As a result, doctors in hospitals are faced with more stringent requirements for the formation of a differential diagnosis. The medical history should be filled in such a way that any medical worker has the opportunity to follow the logic of the attending physician when prescribing diagnostic and therapeutic measures.
Polyclinic doctors should also strive to form a differential diagnosis, however, if this does not work out for them because of a difficult case of the disease, they always have the opportunity to hospitalize the patient for further examination.
University skills
They try to teach such a compelling conclusion to all students of medical universities, but there are significant differences in how exactly teachers try to do it.
If the teacher is not currently a practicing doctor, then he focuses on creating differential tables. The technique of making a differential diagnosis is a very important branch of medical science, but it takes a lot of time. Doctors in a hospital and, especially, in a polyclinic do not possess it. Therefore, practicing specialists teach their wards to give preference to syndromic diagnosis, followed by confirmation or refutation of the diagnosis using laboratory and instrumental techniques.
Differential diagnosis online
Currently, many patients are in no hurry to see a doctor. First of all, they try to find information on the Web. Especially for such patients, sites have been created with the help of which even a lay person is able to make a differential diagnosis that is close to true. It should be noted that the use of such services should not be carried away. Especially if health disorders are serious enough, as this may entail a delay in the start of treatment and a deterioration in well-being.