What is a Diagnosis? A rose by any other name?

You go to see a doctor with a painful shoulder. You tell the doctor that you can’t sleep because of the pain, and the doctor starts to make assumptions about your symptoms.  Before you get a chance to tell the doctor your story, you are told you slept on it wrong, and given a prescription for anti-inflammatory medication.  You don’t really improve and so you see another doctor for a second opinion.  A full history is taken, and you tell the doctor that you play softball on the weekends and you collided with the catcher while trying to score.  The doctor examines you and tells you that you likely have separated your shoulder.  An x-ray is ordered and it shows a shoulder separation.
Unfortunately, quick, easy answers and assumptions frequently lead to an incomplete diagnosis or a misdiagnosis.  These carry costs – your time and your money spent finding the correct answer, but more importantly, your health – which is why you go to the doctor in the first place.  Your story is like a puzzle, separated pieces that depict your diagnosis – the doctor has to put them together.
Your doctor needs to ask the right questions and listen to you to put your puzzle together.  It is what I am trained to do – make a diagnosis.  But what is a diagnosis?

  • A label
  • A code
  • A starting point for treatment

A diagnosis is a term with medical meaning.  It is comes from a physician’s synthesis of a patient’s symptoms, history, physical findings and laboratory findings.  A proper diagnosis is essential to begin a journey towards Wellness!

How does a doctor approach making a diagnosis?  We start by making a list – called a “differential diagnosis.”  As we take a history from a patient we start listing diagnoses that fit the symptoms.  As more of the story unfolds, the list is adjusted, the order is changed, items added and removed.  Then we examine the patient, and again revise the list based on our findings.

Tests are then ordered to do two things.

  • Definitely remove an item from list.
  • Confirm items on the list.

The approach to testing, however, doesn’t always focus on the most likely – there are other factors that determine the order of the tests.  If being wrong about a diagnosis has severe consequences, it may be tested for first even if less likely.

Finally, all the information gathered from the history, physical and diagnostic testing are put together and the list is put into a final order and a diagnosis is made.

If a treatment works, it confirms the diagnosis choice from the list.  If a treatment doesn’t work, the list needs to be re-examined and the history revisited to see what information was missing or not emphasized.  This is a crucial time in communicating with your doctor – they need to know what you are experiencing.  Based on that re-evaluation new tests may be ordered to further refine the list, and so on, until the final answer is revealed.

So what?  Why is this important?

First and foremost it determines treatment.  A diagnosis of Strep Throat requires treatment with antibiotics; a cold does not.
The diagnosis is what is used by insurance companies to approve tests and medications.
Diagnoses determine life insurance rates!

A diagnosis represents the last piece of the puzzle being put into place; it allows you and your doctor to chart a course of treatment and find direction after the confusion of not feeling well.

Without a proper diagnosis, you wander in the medical field, so remember:

The path to wellness begins with a proper diagnosis

 

Author: Eric Goldberg, MD, FACP

I am a Board Certified Internal Medicine physician. I currently practice at and am the Medical Director of NYU Langone Internal Medicine Associates. Posts are my opinion and not medical advice or an official position of NYU Langone Medical Center.

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