September 7, 2012

The Gray Area of Making Diagnosis

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In treating a patient, we are relying on clinical assessment supported by laboratory, diagnostic instrument and imaging test. We need a diagnosis before diving more deeper into it. All of this step will aid a doctor to provide management based on available evidence based medicine. 

However, there are time when thing did not work as we plan. The diagnosis is in vain and the resources are limited for us to proceed. Moreover, the symptoms and signs are mixed and further compromise our ability to determine the primary insult. 

This is the gray area of medicine and it will delay the treatment. The longer we are in this period then the prognosis will be bad.

Medicine is about logic based on the integrated knowledge of the anatomy, physiology and biochemistry of the body function. For every things that happen, there must be a connection  behind it.

When the signs and symptoms sounds did not correlate with the patient’s condition, then we need to look more into it.  It means that there are a missing puzzle that fails us from identifying the connection on what is happening to the patient.

The missing puzzle could be from the inadequate history, lab errors, hidden genetic predisposing factor, lack of knowledge from the healthcare provider in identifying the problems, faulty reasoning and logic and often contributed by a famous quotation “All Patients LIE.”

Therefore, we need to step backward and starts the whole process again and make sure that we did not left any pieces of the puzzle. In between that, it is essential to meet the basic requirement in maintaining patient’s survivability.

They are places that practice defensive medicine. It often scare them to initiate any treatment before knowing the diagnosis. In one aspect, i do agree as it might be not working or worsens the patient’s condition. But in another aspect, i believe that a doctor should be firm in making decision to treat a patient based on the best interest for patient. At least, we should be able to identify what is killing the patient at that particular moment and try to intervene. I also strongly believe that when the diagnosis is in vain, it is not a sin to treat as the most likely diagnosis based on the epidemiology, the most likely condition that can give the presenting symptoms. After all, most of the disease have an overlap pathogenesis. The gray area will always exist and it should not clouded our mind as well.

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