What is the diagnostic process?
Diagnosis of a disease is a complex process to identify the cause of a person’s symptoms and determine (diagnose) the disease or condition (diagnosis) causing symptoms.
First of all, let me provide a simple definition of “disease.” “Disease” is a departure from wellness. Similarly, “wellness” is freedom from disease. If wellness is the same as “at ease,” then “Disease” is the opposite of “at ease.” I will write more about this in another blog.
Suppose a patient presents to the emergency room. The first question will be, “What brought you here today?” The answer to that is the first bit of data. A diagnosis requires putting together multiple bits of data. The data gathered will all be related to the answer to that question. From there, Here’s a general outline of the diagnostic process:
- Medical History: The doctor begins by asking for medical history from the patient, including symptoms, how long you have had them, and any possibly related past medical conditions or family history. This information helps guide further investigations and gets us closer to the diagnosis.
Be ready to answer these questions when you come to the ER. Be able to tell us what conditions run in your family, as several diseases, such as hypertension (high blood pressure) and diabetes, have a genetic or family pattern.
- Physical Examination: The doctor conducts a physical examination, carefully assessing the patient’s body systems and looking for abnormalities, such as rashes, swelling, or unusual sounds in the heart, lungs, or abdomen.
- Differential Diagnosis: The emergency room doctor considers the patient’s symptoms, medical history, and test results to create a list of possible diagnoses, known as a differential diagnosis. They compare the patient’s findings with known patterns of diseases to narrow down the possibilities.
- Diagnostic Tests: The healthcare provider may order various diagnostic tests based on medical history, physical examination, and differential diagnosis. These tests could include blood tests, imaging studies (X-rays, CT scans, MRIs), urine or stool analysis, or other specialized investigations.
The specific tests depend on the suspected disease or condition. For example, if you state your reason for being here is “foot pain after I dropped an anvil on it,” Then likely we will not be doing a brain CT to look for pathology there. But we may be getting an X-Ray of your foot.
History is everything
Again, explaining specifically why you are in the emergency room is essential. Please don’t embellish why you are there under the false premise that “more tests equals more health.”
It is important to note that the diagnostic process can vary depending on the complexity of the condition and the resources available. A definitive diagnosis may sometimes be challenging, requiring further investigations or follow-up. For example, if I find that the cause of your symptoms does not require surgery, then we know your treatment will be medical. Does the medicine need an inpatient stay, or can you treat it at home? That is the outcome of diagnosis in the emergency room. Go home, stay in the hospital, or go to the operating room.
It is essential to understand that diagnosis can be difficult. I often explain to patients: if you come in here with an arrow sticking out of your head, I know all I need to know for the diagnosis. However, if you have abdominal pain or chest pain, it is much more difficult. Those conditions have an extensive differential diagnosis list to go through.
“Differential diagnosis” refers to systematically considering and evaluating various diseases or conditions that could explain a patient’s symptoms. It involves comparing and contrasting the patient’s symptoms, medical history, and test results to narrow the potential diagnoses and identify the most likely one.
Diagnosis in the Emergency Room
You can expect the provider to ask you questions to find out what organ system affects you. They will then order diagnostic tests to help eliminate items off the differential diagnosis, hoping this data will point directly to a single entity causing your symptoms. This process takes time. Blood tests can take over an hour; radiographic imaging can take several hours. And, likely, the provider is constantly responding to more patients coming into the department. At all times in the emergency room, the providers must see the sickest patients first. We must do it this way to fulfill our mission: to save life and limb. But, we will treat everybody fairly.
If the diagnosis is severe, you will go to the operating room or be admitted for medical treatment. If there is no severe condition, you will be discharged home to follow up with your primary care doctor.
Copyright 2023 William E. Franklin, DO, MBA
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