'''Medical diagnosis''' (abbreviated '''Dx''', '''D<sub>x</sub>''', or '''D<sub>s</sub>''') is the process of determining which [[disease]] or condition explains a person's [[symptom]]s and [[medical sign|signs]]. It is most often referred to as '''diagnosis''' with the [[medicine|medical]] context being implicit. The information required for diagnosis is typically collected from a [[medical history|history]] and [[physical examination]] of the person seeking medical care. Often, one or more '''diagnostic procedures''', such as [[medical test]]s, are also done during the process. Sometimes [[posthumous diagnosis]] is considered a kind of medical diagnosis.
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多くの徴候や症状が[[sensitivity and specificity/ja|非特異的]]であるため、診断はしばしば困難である。例えば、[[skin/ja|皮膚]]の発赤（[[erythema/ja|紅斑]]）は、それだけでは多くの疾患の徴候であるため、何が悪いのかを医療専門家に伝えることはできない。したがって、いくつかの可能性のある説明を比較対照する[[differential diagnosis/ja|鑑別診断]]を行わなければならない。これには、さまざまな情報の[[correlation/ja|相関]]に続いて、パターンの認識と鑑別が含まれる。時には、[[pathognomonic/ja|病理]]的な徴候や症状（あるいはいくつかの症状群）によって、このプロセスが容易になることもある。
Diagnosis is often challenging because many signs and symptoms are [[sensitivity and specificity|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]].
Diagnosis is a major component of the [[Doctor's visit#Procedure|procedure of a doctor's visit]]. From the point of view of [[statistics]], the diagnostic procedure involves [[classification test]]s.
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== 医学的用途 ==
== Medical uses ==
{{Anchor|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 diagnostic procedure may be performed by various [[healthcare professional]]s such as a [[physician]], [[physiotherapist]], [[dentist]], [[podiatrist]], [[optometrist]], [[nurse practitioner]], [[Healthcare science|healthcare scientist]] 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 (medicine)|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.
* 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.
* 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 [[radiology|radiological]] studies like [[magnetic resonance imaging]] or [[blood test]] panels that also include blood tests that are not relevant for the ongoing diagnosis.
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== 手順 ==
== Procedure ==
{{Anchor|Procedure}}
General components which are present in a diagnostic procedure in most of the various available methods include:
利用可能なほとんどの診断方法において、診断手順に含まれる一般的な構成要素には以下のものがある：
* 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 test]]s.<br> 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.
There are a number of methods or techniques that can be used in a diagnostic procedure, including performing a [[differential diagnosis]] or following [[medical algorithm]]s. In reality, a diagnostic procedure may involve components of multiple methods.
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=== 鑑別診断 ===
=== Differential diagnosis ===
{{Main/ja|Differential diagnosis/ja}}
{{Main|Differential diagnosis}}
鑑別診断の方法は、徴候や症状の原因となりうる可能性のある疾患や病態の候補をできるだけ多く見つけることに基づいており、その後、[[process of elimination/ja|消去法]]、あるいは少なくとも、さらなる[[medical test/ja|医学的検査]]やその他の処理によって項目の可能性を高くしたり低くしたりして、可能性のある疾患や病態の候補が1つだけ残る時点に到達することを目指す。その結果、可能性のある病態のリストが残り、確率や重症度の高い順にランク付けされることもある。このようなリストはしばしばコンピュータ支援診断システムによって作成される。
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 test]]s 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.
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この方法による診断結果は、多かれ少なかれ[[diagnosis of exclusion/ja|除外診断]]とみなすことができる。診断の結果、可能性のある疾患や病態がひとつも見つからなかったとしても、少なくとも生命を脅かすような病態を除外することはできる。
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.
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.
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 [[Association (psychology)|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.
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=== 診断基準 ===
=== Diagnostic criteria ===
{{Main|Clinical case definition}}
{{Main|Clinical case definition}}
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.
''診断基準''という用語は、[[clinician/ja|臨床医]]が正しい診断を下すために用いる[[signs and symptoms/ja|徴候・症状]]、検査結果の特定の組み合わせを指す。
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[[clinical case definition/ja|臨床症例の定義]]としても知られる診断基準の例には、以下のようなものがある：
Some examples of diagnostic criteria, also known as [[clinical case definition]]s, are:
* [[Centor criteria]] for [[Streptococcal pharyngitis|strep throat]]
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=== 臨床判断支援システム===
=== Clinical decision support system ===
[[Clinical decision support system/ja|臨床判断支援システム]]は、医療専門家の意思決定作業を支援するために設計された対話型コンピュータプログラムである。臨床医は臨床医の知識とソフトウエアの両方を活用してソフトウエアと対話し、人間やソフトウエアが単独で行うよりも優れた患者データの分析を行う。 通常、システムは臨床医が目を通すべき示唆を与え、臨床医は有用な情報を選び、誤った示唆を取り除く。心臓モニターの出力を読み取るなど、臨床医の代わりにこれを行おうとするプログラムもある。 このような自動化プロセスは、通常FDAによって「装置」とみなされ、規制当局の承認が必要となる。対照的に、臨床医を「支援」するが、臨床医の代わりにはならない臨床判断支援システムは、(1)基礎となるデータを明らかにする、(2)その根底にある論理を明らかにしている、(3)臨床医に判断を委ねるのFDA基準を満たす場合、「拡張知能」とみなされる。
[[Clinical decision support system]]s 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. 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.
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=== その他の診断手技の方法 ===
=== Other diagnostic procedure methods ===
診断手技を行う際に使用できるその他の方法には、以下のようなものがある：
Other methods that can be used in performing a diagnostic procedure include:
[[File:Assessment and treatment algorithm for overweight and obesity.png|thumb|350px|[[overweight/ja|過体重]]と[[obesity/ja|肥満]]の評価と治療のための医療アルゴリズムの一例。]]
[[File:Assessment and treatment algorithm for overweight and obesity.png|thumb|350px|An example of a medical algorithm for assessment and treatment of [[overweight]] and [[obesity]].]]
* [[medical algorithm/ja|医療アルゴリズム]]の使用法
* Usage of [[medical algorithm]]s
* 可能な限りの質問をし、可能な限りのデータを収集する「網羅的手法」
* An "exhaustive method", in which every possible question is asked and all possible data is collected.
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== 副作用 ==
== Adverse effects ==
{{Anchor|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.
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.
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=== エラー===
=== Errors ===
{{Further/ja|Medical error/ja}}
{{Further|Medical error}}
[[:en:National Academies of Sciences, Engineering, and Medicine|米国科学・工学・医学アカデミー]]による2015年の報告書によれば、ほとんどの人が生涯に少なくとも1回は診断ミスを経験する。
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]].
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診断ミスの原因と要因は以下の通りである：
Causes and factors of error in diagnosis are:
* 病気の症状が十分に目立たない
* the manifestation of disease are not sufficiently noticeable
* ある疾患が考慮から漏れている
* a disease is omitted from consideration
* 診断のある側面が重要視されすぎている
* too much significance is given to some aspect of the diagnosis
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:
* ''発症から受診までのタイムラグ'', [[symptom/ja|症状]]の発症から[[health care provider/ja|医療機関]]を受診するまでの期間
* ''Onset-to-medical encounter lag time'', the time from onset of [[symptom]]s until visiting a [[health care provider]]
* ''受診から診断までのタイムラグ'', 初診から診断までの期間
* ''Encounter-to-diagnosis lag time'', the time from first medical encounter to diagnosis
** 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.
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長いタイムラグはしばしば「診断オデッセイ」と呼ばれる。
Long lag times are often called "diagnostic odyssey".
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== 歴史 ==
== History ==
{{Anchor|History}}
{{Main|History of medical diagnosis}}
{{Main/ja|History of medical diagnosis/ja}}
The first recorded examples of medical diagnosis are found in the writings of [[Imhotep]] (2630–2611 BC) in [[ancient Egypt]] (the [[Edwin Smith Papyrus]]). A [[Babylonia]]n medical textbook, the ''Diagnostic Handbook'' written by [[Esagil-kin-apli]] ([[floruit|fl.]]1069–1046 BC), introduced the use of [[empiricism]], [[logic]] and [[rationality]] in the diagnosis of an illness or [[disease]]. [[Traditional Chinese Medicine]], as described in the Yellow Emperor's Inner Canon or [[Huangdi Neijing]], specified four diagnostic methods: inspection, auscultation-olfaction, interrogation, and [[palpation]]. [[Hippocrates]] was known to make diagnoses by tasting his patients' urine and smelling their sweat.
医学的診断の最初の記録例は、[[:ja:古代エジプト|古代エジプト]]の[[:en:Imhotep|イムホテプ]]（紀元前2630年-2611年）の著作（[[:en:Edwin Smith Papyrus|エドウィン・スミス・パピルス]]）に見られる。[[:en:Babylonia|バビロニア]]の[[:en:Esagil-kin-apli|Esagil-kin-apli]]（[[:en:floruit|fl.]]紀元前1069年-1046年）によって書かれた[[バビロニア]]の医学書である''診断ハンドブック''では、病気や[[disease/ja|疾患]]の診断に[[empiricism/ja|経験主義]]、[[logic/ja|論理]]、[[rationality/ja|合理性]]を用いることが紹介されている。[[Traditional Chinese Medicine/ja|中国伝統医学]]は、[[:en:Huangdi Neijing|黄帝内経]]に記載されているように、4つの診断方法：検査、聴診-嗅覚、問診、[[palpation/ja|触診]]を規定していた。[[:en:Hippocrates|ヒポクラテス]]は患者の尿を味見し、汗の匂いを嗅いで診断を下すことで知られていた。
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 word ''[[wikt: diagnosis|diagnosis]]'' {{IPAc-en|d|aɪ|.|ə|ɡ|ˈ|n|oʊ|s|ᵻ|s}} is derived through [[Latin]] from the [[Ancient Greek|Greek]] word διάγνωσις (''diágnōsis'') from διαγιγνώσκειν (''diagignṓskein''), meaning "to discern, distinguish".
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==社会と文化==
== Society and culture ==
{{Anchor|Society and culture}}
=== Social context ===
=== 社会的背景 ===
Diagnosis can take many forms. 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's 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 be [[pathogenic]] or [[salutogenic]]. It's 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 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 [[monitoring (medicine)|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.
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関連する情報は、患者の[[medical record/ja|医療記録]]に追加されるべきである。
Relevant information should be added to the [[medical record]] of the patient.
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通常有効であるはずの治療に反応しない場合は、診断の見直しが必要であることを示している。
A failure to respond to treatments that would normally work may indicate a need for review of the diagnosis.
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Nancy McWilliamsは、診断が必要であると判断する5つの理由を特定している:
Nancy McWilliams identifies five reasons that determine the necessity for diagnosis:
* 治療計画のための診断
* diagnosis for treatment planning;
* 予後に関する情報
* information contained in it related to prognosis;
* 患者の利益保護
* protecting interests of patients;
* 診断はセラピストが患者に共感するのに役立つかもしれない
* a diagnosis might help the therapist to empathize with his patient;
* 治療への恐怖感を軽減する可能性
* might reduce the likelihood that some fearful patients will go-by the treatment.
: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.
:A diagnosis based on the macroscopic, microscopic, and molecular examination of tissues such as biopsies or whole organs. For example, a definitive diagnosis of [[cancer]] is made via tissue examination by a [[pathologist]].
:The single medical diagnosis that is most relevant to the patient's [[chief complaint]] or need for treatment. Many patients have additional diagnoses.
: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.
;[[Diagnostic criteria/ja|診断基準]]
;[[Differential diagnosis]]
:[[clinician/ja|臨床医]]が正しい診断を下すために用いる[[sign (medicine)/ja|徴候]]、[[symptom/ja|症状]]、検査結果の組み合わせを指す。通常、国際的な委員会によって発表される標準であり、最先端の技術を駆使して病態の存在を尊重し、可能な限り最高の[[sensitivity and specificity/ja|感度と特異度]]を提供するように設計されている。
: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.
;[[Prenatal diagnosis/ja|出生前診断]]
;[[Diagnostic criteria]]
:出生前に行われた診断作業
:Designates the combination of [[sign (medicine)|signs]], [[symptom]]s, 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 state-of-the-art technology.
: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.
;[[Self-diagnosis/ja|自己診断]]
;[[Dual diagnosis]]
:自分自身の病状を診断したり、特定したりすること。 自己診断は非常に一般的である。
: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.
: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.
;[[Overdiagnosis/ja|過剰診断]]
;[[Computer-aided diagnosis]]
:患者が生きている間に症状や苦痛、死亡を引き起こすことのない "病気 "と診断される。
:Providing [[symptoms]] allows the computer to identify the problem and [[diagnose]] the user to the best of its ability. Health screening begins by identifying the part of the body where the symptoms are located; the computer cross-references a database for the corresponding [[disease]] and presents a diagnosis.
:A vague, or even completely fake, medical or psychiatric label given to the patient or to the [[medical record]]s department for essentially non-medical reasons, such as to reassure the patient by providing an official-sounding label, to make the provider look effective, or to obtain approval for treatment. This term is also used as a derogatory label for disputed, poorly described, overused, or questionably classified diagnoses, such as [[pouchitis]] and [[senility]], or to dismiss diagnoses that amount to [[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.
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