The scope of diagnosis – some thoughts after attending #DEM2018
This past weekend I participated in the Society to Improve Medical Diagnosis annual meeting. I saw many old and new friends. Going to a meeting often stimulates thinking. Because we often talk about diagnostic errors, we must first define diagnosis. As I listened to talks, observed posters, and talked with colleagues a broader concept occurred. Probably others have considered this, and if so, please send me the reference.
Diagnosis has several levels. A patient coming to see either a primary care physician, cardiologist, emergency physician or someone else (including urgent care, nurse practitioners, and physician assistants) because they have significant chest pain triggers a search for a diagnosis. Similarly, a patient with 20 pound weight loss (plus or minus other symptoms) might trigger a search for a diagnosis. These examples of diagnosis are rather clear.
But the situations I began to think about are rather different. Let’s outline 3 such examples:
A patient has a sodium of 120 – the diagnostic question is why. We first need to understand the immediate cause of the hyponatremia, but then we often need to examine the underlying diagnosis.
A patient with known COPD comes to see you for worsening dyspnea. Sometimes we label that as COPD exacerbation – but what is the real diagnosis causing the exacerbation?
A patient presents with a creatinine of 3 with a known recent creatinine of 1.2. Often we make the “diagnosis” of...
Source: DB's Medical Rants - Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
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