The story of medical diagnosis

The story of Medical Diagnosis


                                                        by   p.ganesh

       

     The following is an imaginative and serious incident that happens in a medical college classroom. It is about a conversation that takes place between an actor as a doctor, a real senior Doctor and students.
   
    The Doctors explain their students the process of Diagnosis while the students are present.

    The Senior Doctor knows medicine completely as he is a doctor .
     He also knows how to hold the clinical signs in head while estimating the problem. He knows how to use the analysis methods and communicate dynamically. How could they explain this to students who study medicine but who need to know analysis and communication by using brain dynamically ? Analysis is the key here. 

    The doctor and the actor starts the talks from here.

Sr. Doctor:    
                   An interaction between a physician and a patient results in diagnosis. It is a routine in clinical practice where diagnosis ends in a therapy for the patient.

Actor :    
                  Patient never understands this process. He usually gets upset because he’s sick. He cannot talk or he talk’s only half. All he needs is medicine and he would like to get well.

Sr. Doctor :
                    A doctor is expected to make clear decisions on estimating the problem. Sometimes conclusions cannot be made and the possibility of a mistake  is real. Instead of explaining it to patients the doctors  are pressured to make decisions in such circumstances .Errors occur due to incomplete or partial information received from patients.


Actor : 
    Mistakes should not occur. The doctors are expected to question the patients completely during diagnosis. With whatever medical knowledge they have they are expected to come to a conclusion.    The doctors are expected to take complete control over the situation. Initially they have to let the patient talk. Then doctor has to ask questions with expected answers. Then come to a conclusion based on answers through analysis. Thus a common disease or a rare disorder can be found only by Questioning. For this Doctors have to spend time with Patients. This needs dedication in service, their job.

Sr. Doctor :
                    The traditional view of the diagnostic process is of analytical reasoning that includes generation of hypothesis, their testing and verification based on patient data through a conscious deductive process. Nowadays skilled physicians use a non-analytical reasoning, based on pattern recognition. They diagnose by matching the clinical pattern with memory.
     Uncomplicated diseases can be diagnosed by pattern recognition while a rare disorder can be diagnosed through analysis. Background of the patient like age, sex, family history and local conditions make it easy for diagnosis.
     Skilled physicians follow patterns of symptoms to get to a conclusion. The medical texts are organized around disease categories rather than on clinical representations.

Actor :
        The doctors while doing the pattern recognition must be able to cure on their first attempt. If a patient is appearing for continues problems then the analytical method has to be used.

Sr. Doctor :
     The logic of medical diagnosis is not specific. It moves from a set of specific facts to a general conclusion.

Actor :
     Since nothing is fixed, what is positive for 100 patients with disease might be  negative for 101st patient with disease.

Sr. Doctor:
     Some conditions are diagnosed on pathology obtained by biopsy, others rely on radiological and laboratory tests or clinical signs. Some times even these tests can lie leading to errors. Some procedures produce definite evidence while others do not. Those positive on such tests are confirmed on expensive or elaborate tests
     Predictions about the presence or absence of the disease must be done for most optimal interpretation of results.

Actor:
     The doctor has to predict properly .For this he has to know the symptoms properly and recommend tests properly.

Sr. Doctor:
     Physicians often prize the evidence supported narratives of diseases. They do not examine the probabilistic nature of the process of diagnosis.Expertise is not a static, but dynamic state.
     Good clinicians regularly review patient data, revalidate the patterns identified, examine the probabilities and have the courage to question their earlier diagnostic interpretations allowing them to reassign risks and diagnosis.
     It is often difficult for patients to evaluate the evidence and arrive to any conclusion.

Actor :
     Proper diagnosis has to be made to rectify a problem. Today’s Doctors do not spare enough time with the patients. Hygiene in hospitals has to be maintained. communication skill has to be there as a subject in the medical colleges. The doctors have to master their subjects during their college days and apply it on job. Doctors have to have a passion in their job. Every patient must be taken in as a challenge to be cured. Concentration and attention has to be given during consultation. Partial information should not be gathered from the patient.Analysis of possibilities has to be mastered. This is an art that can be mastered using brain and hindsight.

       With this, the speech by the actor and the senior doctor concluded. While both were coming out of the class room the actor was heard telling the senior doctor that the future of the medical field should have medical students who should know the value of life, suffering of pain, cost of medicines and their affordability, proper medical facilities for the public, service motto, meaning of favor, human rights, communication skill, subject knowledge, analytical skill, thinking power, and proper diagnosis of the problem. Since all the above can be understood except diagnosis of a problem ;  as it involves with a probability being high. Since, a doctor too is human, with all the power of his medical education and thinking power, he should cure the patients .Man should keep conquering the infinities of human body mysteries and only after all that a doctor is allowed to say “It’s all left to God”.

Ref. : Medical diagnosis : process and pitfalls
              By K.S.Jacob,
            Professor , Christian medical  college , vellore. 
From – The Hindu, dated Jan. 6, 2010.



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