Diagnosis (i.e. diagnosis) is the process of recognizing a disease, which includes targeted medical examinations along with the interpretation of the results and their generalization in the form of an established diagnosis.
What does the diagnosis include?
Diagnostics includes three basic sections:
- Semiotics.
- Methods of diagnostic examination (or diagnostic equipment).
- Conducting a differential diagnosis.
Types of diagnosis
At the stage of examination and therapy of the patient, the diagnosis can be constantly updated. In this regard, respectively, distinguish:
- Preliminary diagnosis. That is, the diagnosis, which is formulated directly in the framework of the patient’s request for medical help, based on the data of the initial examination. A preliminary diagnosis is often erroneous.
- The main diagnosis is based on clinical examinations.
- The final diagnosis is formulated at the end of the examination and treatment of the patient, and in addition, in connection with his discharge from the hospital or because of death.
Online Diagnosis
Among other things, today it is necessary to recognize the presence of an early, and at the same time non-medical stage in the diagnosis, we are talking about self-diagnosis (that is, the so-called diagnosis on the Internet). Thanks to modern conditions, anyone can find the symptoms of interest on the Internet. Based on the information received on the Web, people draw conclusions. But such conclusions will be biased, and in addition unreasonable, and also intimidating the patient.
Difficulties in diagnosis and errors
There are more than one hundred million all kinds of diseases, and every day new pathologies appear. Each disease has a described classical clinical picture, which is studied by students of medical universities, but almost every pathology also has various forms along with degrees of severity, course, atypical manifestations, and so on. Do not forget that the patient may have several diseases at once, some manifestations and symptoms are superimposed on others. In addition, all sorts of complications arise, which also change the classic manifestation of pathology.
All people are essentially different. Each has its own morphology, along with metabolism and protective reactions of the body. The same pathology can manifest itself very differently in patients. Very often, the patient himself can contribute to a change in the clinical picture, for example, taking medications without a doctor's prescription. Well, of course, patients can distort information and lie.
Physician Factor
Of course, the doctor’s factor often influences the occurrence of errors in the diagnosis. All doctors are primarily the same people as their patients, and, as you know, everyone tends to make mistakes. A doctor may simply not know or simply forget about a particular disease or medical nuance. A physician may simply not have enough experience or, on the contrary, many years of practice of monotonous clinical activity will obscure the conduct of differential complex diagnostics. Doctors have small salaries, in connection with this, many of them work at once on several jobs or are often on duty at night. And against the background of all this, fatigue can negatively affect the whole work as a whole.
Thus, in fact, errors in the diagnosis are the most common type of medical errors. In most situations, their appearance does not directly depend on the lack of knowledge, but on the banal inability to use it. Indiscriminate diagnostic searches, even using the most modern special techniques, are unproductive.
Consider the basic rules of diagnosis below.
Diagnosis
The conclusion of the entire diagnostic process is the formulation of the diagnosis. It should contain the name of a particular disease, reflecting its essence. Clinical diagnosis elements clarify this essence (by pathogenesis, etiology, functional disorders, etc.) or give an idea of the course of the disease, which can be acute, subacute, protracted, or chronic.
After the diagnosis is made, treatment is selected.
In addition, the formulation of the diagnosis contains information about the complications of the pathology, the period of exacerbations or remissions, its stages, and if there are inflammatory processes about the phases of the disease (active or inactive) and the degree of its activity.
Psychological diagnosis
The practice of using a variety of psychodiagnostic tests to study the personality is inextricably linked with the concept of psychological diagnosis. The very concept of “diagnosis” (that is, the research procedure) is widely used in completely different areas, since the task of recognizing, and in addition, determining the characteristics of certain manifestations, is not at all considered only the prerogative of medicine.
In the literature there are many definitions for such a thing as a "psychological diagnosis." The medical definition of the diagnosis, which is strongly associated with the disease and abnormalities, was reflected in the characterization of this concept in the field of psychological science. In this interpretation, the psychological diagnosis always serves to identify the hidden causes of the revealed dysfunction. Diagnosis, wherever it is, whether in medicine, in management, or in the field of psychology, is always first and foremost a search combined with the identification of hidden causes. Next, consider what constitutes a clinical diagnosis.
Clinical diagnosis
The clinical diagnosis is a full-fledged, subjective conclusion obtained in the course of differential diagnosis, which is a relative objective truth. The clinical diagnosis must be made in terms that do not exceed three days of the patient's stay in the hospital. Such a diagnosis should be made on the cover page, indicating the date of its installation and the signature of the doctor who made the diagnosis. The date of establishment of the clinical diagnosis and the day of its justification should coincide in the medical history.
In the event that the diagnosis is not already in doubt within the framework of the initial examination of the patient (especially in cases of frequent hospitalization of a person in a certain department), then the correct diagnosis can be justified and formulated directly on the day the person arrives at the hospital.
Requirements
In the process of justification and preparation of a clinical diagnosis, certain requirements must be observed, for example:
- The diagnosis must be formulated on the basis of nosological principles, and at the same time it should be uniform along with full encryption, taking into account the accepted international classification of pathologies of the latest revision. In addition, expressions and terms that allow conflicting and dual encryption should be avoided. It is also undesirable eponymous (named after) designation of pathologies and syndromes.
What are the other criteria for diagnosis?
- The clinical diagnosis must necessarily be complete. In order to more fully disclose the features of a particular case, and at the same time, for a more informative diagnosis, it is necessary to apply a generally accepted classification with additional intranosological characteristics (we are talking about the clinical form, syndrome, type of course, degree of activity, stage, functional impairment, and so on) .
- The justification of the diagnosis should be carried out according to each nuance of the formulated conclusion. As criteria in the framework of the justification of the diagnosis, significant, and in addition, significant symptoms with signs in combination with the results of the differential diagnosis with pathologies that are included in the study should be used. The pathology recognition pathway should be as economical as possible.
- The clinical diagnosis during observation and therapy should be reviewed critically, and in addition, supplemented and refined. It should reflect the dynamics of structural and functional damage, changes in the patient's condition (phase change, stage, degree of compensation). It should also take into account the addition of complications, intercurrent diseases, as well as the favorable and unfavorable consequences of treatment and rehabilitation. The rules for diagnosis must be strictly followed.
- The diagnosis must be timely and established in an extremely short time.
- In the course of formulating a clinical diagnosis, the underlying disease, its complications and associated pathologies are sequentially indicated.
Now consider the methods for diagnosing pathologies.
Diagnostic Methods
Modern medicine is rich in various possibilities for conducting a detailed study of the functioning of organs and their structure. Nowadays, a quick and accurate diagnosis of diseases and any deviations from the norm is possible. Laboratory diagnosis methods to a greater extent reflect problems at the cellular and subcellular levels. Thanks to the methods of diagnosis, it is possible to judge the occurrence of breakdowns in specific organs. In order to see what exactly is happening in a particular organ, in particular, instrumental diagnostic techniques are used.
Some studies are used only to identify a specific pathology. True, many diagnostic procedures are essentially universal and are used by doctors of various specialties. Screening tests are carried out to identify pathologies whose symptoms have not yet manifested or are weakly noticeable. An example of such a test is fluorography, which allows the detection of lung diseases at various stages. Screening tests are fairly accurate. The research procedure itself is relatively inexpensive, and its implementation is not harmful to health.
Clinical blood test
Screening tests include some laboratory diagnostic methods in the form of blood and urine tests. The most common study is the well-known clinical blood test, which is the main way to evaluate shaped blood elements. Blood for research purposes, as a rule, is obtained from the capillaries of the finger.
In addition to the number of elements such as red blood cells, white blood cells and platelets, the percentage of hemoglobin, the size and shape of the cells, and so on, are determined. In addition, using this diagnostic method, the number of reticulocytes (i.e., immature red blood cells that have a nucleus) is determined. A clinical blood test makes it possible to diagnose most blood pathologies (anemia, leukemia and others), and in addition, to evaluate the dynamics of inflammatory processes along with the effectiveness of the therapy. And thanks to the methods of diagnosis as a whole, it is possible to detect developing pathologies in time.