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: Tags: Medical Rants Source Type: blogs