Medical diagnosis/ja: Difference between revisions

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=== Differential diagnosis ===

{{Main|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 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.

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.

If unexpected findings are made during this process, the initial [[hypothesis]] may be ruled out and the provider must then consider other hypotheses.

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=== Pattern recognition ===

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.

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=== Diagnostic criteria ===

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.

Some examples of diagnostic criteria, also known as [[clinical case definition]]s, are:

* [[Amsterdam criteria]] for [[hereditary nonpolyposis colorectal cancer]]

* [[McDonald criteria]] for [[multiple sclerosis]]

* [[Systemic lupus erythematosus#Diagnostic criteria|ACR criteria for systemic lupus erythematosus]]

* [[Centor criteria]] for [[Streptococcal pharyngitis|strep throat]]

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=== Clinical decision support system ===

[[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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=== Other diagnostic procedure methods ===

[[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]].]]

* Usage of [[medical algorithm]]s

* An "exhaustive method", in which every possible question is asked and all possible data is collected.

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== Adverse effects ==

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=== Overdiagnosis ===

{{Main|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.

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=== Errors ===

{{Further|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 Medicine]].

* 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 [[wikt:presentation|presentation]]

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=== Lag time ===

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 [[symptom]]s until visiting a [[health care provider]]

* ''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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== History ==

{{Main|History of medical diagnosis}}

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.

== {{anchor|Etymology}}Word ==

{{Main|Wiktionary:diagnosis}}

The plural of diagnosis is ''diagnoses''. The verb is ''to diagnose, ''and a person who diagnoses is called a ''diagnostician''.

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=== Etymology ===

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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== Society and culture ==

=== Social context ===

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.

Relevant information should be added to the [[medical record]] of the patient.

Nancy McWilliams identifies five reasons that determine the necessity for diagnosis:

* diagnosis for treatment planning;

* information contained in it related to prognosis;

* protecting interests of patients;

* a diagnosis might help the therapist to empathize with his patient;

* might reduce the likelihood that some fearful patients will go-by the treatment.