The etiological concept of diseases and the methodology of treatment varies among the different systems of medicine. However, the mode of disease diagnosis (Nosological diagnosis) is common for all systems. It is a fact that the close association between disease diagnosis and remedial diagnosis prevailed in Modern medicine may not be seen in other holistic systems, however, diagnosis is having its own importance even in other systems. The mode of treatment may be either holistic treatment, specific treatment, symptomatic treatment and general life support to the patient. Modern medicine gives more importance to the specific treatment, whereas, systems like Ayurveda, Homoeopathy, Siddha, Unani, Chinese medicine, Naturopathy etc. give more importance to the holistic concept of treatment, i. e. remedy section by considering the physical, mental and emotional characters and life situation of the sick individual.
However, in these systems also, disease diagnosis is equally important, because, under certain situations, the functioning of the affected organ or the system of the body has to be backed up. The patient also may require some specific type of support, for which the organ remedies are to be deployed. Apart from that, disease diagnosis is important for planning the disease control measures, prognosis, special precautions, to know the life threatening situations, prevention of spreading of disease to others. Diagnosis is very essential for statistics, research and also to fulfill the academic interests. Above all, due to some medico-legal reasons, the doctor should know the detailed health status of his patient. Due to all these reasons, disease diagnosis is a must, irrespective of the system of treatment given to the patient.
Disease diagnosis and remedial diagnosis can be considered as the two sides of the same coin, hence, both are having equal importance. Disease diagnosis is done by correlating the signs and symptoms of the patients (clinical features) with the information given by the bystanders and the lab investigation reports. On certain situations, there may be some difficulty in making a diagnosis, because, a number of diseases are having almost similar clinical features. Moreover, rarely occurring diseases or a newly emerged disease may not be identified easily, especially by a general practitioner. Under such circumstances, a specialist’s opinion may be needed. Very rarely, a team of doctors are involved in the process of diagnosis.
It is not possible to name each and every disease we come across in our day to day practice. As per the International Classification of Diseases (ICD-10), a notable percentage of diseases can’t be named. In such cases, a diagnosis is possible in spite of having several health related symptoms in the patient. Since the patient is suffering, he has to be treated symptomatically. Some symptoms or conditions are wrongly understood as diseases by the laymen. For example, clinical manifestations like jaundice, fever, vomiting, headache, malaise etc are not diseases; but clinical manifestations of some diseases. The naming of diseases is done on several basis. Most of the diseases are named after the person who invented that particular disease (Buerger’s disease, Alzheimer’s disease, Weil’s disease), some diseases on the basis of area where the disease is common or identified for the first time (African sleeping sickness, Madhura foot, Japanese encephalitis), on the basis of some peculiarity of the symptoms (Chikungunya), or on the basis of the organism responsible for the infection (Falsiparum malaria, Amoebic dysentery, Bacillary dysentery), or on the basis of the affected organ (Myocarditis, Nephritis, Appendicitis), on the basis of cause(Alcoholic hepatitis, Wool-sorter’s disease), on the basis of age (Juvenile rheumatoid arthritis, Senile dementia), on the basis of pathology(Mixed connective tissue disease, Mucopolyscaccharidosis)etc.
If a group of specific signs and symptoms are found in an individual, it is called syndrome (Edward syndrome, Down syndrome, Laurence-moon syndrome). Nowadays, we hardly come across a patient having a single disease, whereas most of patients are having a list of diseases such as cardiovascular disease, diabetes, idiopathic hypertension, acid peptic disease, senile dementia, degenerative joint disease etc. Many diseases are classified under certain group of disorders. For example: Degenerative joint disorders, Inflammatory bowel disorders, Psychosomatic diseases, Life style disorders etc. Here, each group includes several diseases, but are grouped together due to some common features such as pathological or etiological features.
When a person comes to the doctor for the first time, immediate disease diagnosis may not be possible due to various reasons. However, considering the presenting clinical features and history given by the patient, the doctor can come to a provisional disease diagnosis. After doing the laboratory investigations, the final diagnosis is done by correlating the clinical findings with investigation reports. However the treatment is not kept in pending till the final diagnosis, especially in case of life threatening diseases such as diphtheria, wherein the treatment has to be started immediately when the disease is suspected, because, if we wait for the lab reports to come, the patient may be critical. Some recent laboratory tests help in early diagnosis, but unavailability of sophisticated labs doing such tests is a major deficiency faced by many countries.
The development of science and technology has made a revolution in medical science. Now the concept of disease diagnosis done only on the basis of clinical examination is outdated. It is now under the custody of some sophisticated machines and laboratory techniques, a few out of them pose more risk to the health. But, the noteworthy point is, under all lab reports, a disclaimer is written as “correlate with clinical findings”, which emphasizes the importance of case taking and clinical examination done by the doctor. In this era, wherein doctor-patient relationship is disrupted, we come across many patients saying that the doctor has abruptly prescribed the medicine or referred for lab test without asking much questions and doing any sort of clinical examination.
The recent studies conducted at Mc Master university on the disease diagnosis is remarkable. They found that the name of the disease creates more panic among the patients. For example, a person having sour eructation may not feel bad when the doctor says that he has acidity, on the other hand, he may get embarrassed if the doctor tells him that he has Gastro-esophageal reflex disease, which is the medical terminology for recurrent burning eructations. The same thing happens in most of the cancer patients; once the disease is diagnosed as cancer, the patients mental and emotional status starts deteriorating. But, the doctor cant hide the disease from the patient due to several medical and legal issues. The better alternative is to secretly tell the diagnosis to the bystanders of the patient.
For an accurate disease diagnosis, the cooperation from the patient and his family members is very essential. Each and every problem felt by the patient should be told to the doctor. Some silly matter for the patient may be a vital point for a diagnosis and treatment. Similarly, symptoms of long duration may be ignored by some patients. Purposeful hiding of symptoms can be dangerous. Some patients do not tell the doctor about the treatment he had taken previously. Frequent change of doctor (doctor shopping) can also cause difficulties. During consultation, patients habits, life situations, characters, food and bowel habits, relationship with others etc should be told. The reports of previous treatment and investigations should be told, which may save the time needed for a diagnosis. Hence always ask for a discharge summary while getting discharged from any hospitals. While consulting a doctor, always take one person who knows about the patient. The patient can also note down his symptoms before going for a consultation, so that he will not forget to tell his symptoms completely. In this busy life, there is a trend that instead of patient going to the doctor, he sends somebody to the doctor for a “consultation”. Also there is an increase of people preferring over-the-counter purchase of drugs without a prescription.
When a patient dies or becomes serious during the course of treatment, the next step is to file a suit against the doctor or by attacking the doctors and hospitals, as a result of an emotional outbreak and a preconceived idea that it was due to medical negligence. Nowadays this is a common story in most of the news papers. By promoting the doctor-patient relation ship (which is deteriorating nowadays), and also by going back to the “outdated” family doctor concept, we can solve most of the health related issues.
Source by Dr Muhammed Rafeeque BHMS