The Diagnostic Process A BRIEF OVERVIEW diagnostic process What is it? to figure out to problem...
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Transcript of The Diagnostic Process A BRIEF OVERVIEW diagnostic process What is it? to figure out to problem...
![Page 1: The Diagnostic Process A BRIEF OVERVIEW diagnostic process What is it? to figure out to problem solve method scheme.](https://reader036.fdocuments.us/reader036/viewer/2022062423/5697c0071a28abf838cc624e/html5/thumbnails/1.jpg)
The Diagnostic
Process
A BRIEF OVERVIEW
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diagnostic
process
What is it?
•to figure out•to problem solve
•method•scheme
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Define Problem
Gather Evidence
Form Hypothesis
Test Hypothesis
KNOWLEDGE
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KNOWLEDGE
Define Problem
Test Hypothesis
Form Hypothesis
Patient’sComplaint
Gather Evidence
HistoryPhysical
Lab
DifferentialDiagnosis
TreatmentMEDICAL
KNOWLEDGEBASE
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“The specific intervention (treatment) is less important to the [patient’s] outcome than the process of the interaction.”
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The Science of Medicine
Units of observation
Quantities of measurement
Instrument for obtaining measurement
Signs and symptoms
Words and sometimes numbers
collecting the database:
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Gathering Information
ValidReliableDiscriminatory
characteristics of good data:
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ValidValid
Appropriate to the problem
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Reliable:Reliable:Objective
– free from misinterpretation based on bias or feeling
Precise – represent the true data
Reproducible– different observers obtain the
same results
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SensitiveSensitive::– able to pick-up or detect real disease
Specific:Specific:
Discriminatory:Discriminatory:
– able to rule-out disease in healthy people.
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Gathering Information
medical historyphysical
examinationdiagnostic testingtreatment outcome
the clinical database:
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Medical History:Medical History:
Validity
Reliability
80% of diagnoses can be made by history alone
subjective nature of symptoms; subject to patient interpretation.
poor from patient to patient for a given condition+/- for same patient on separate occasions
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Physical Exam:Physical Exam:
Reliabiliy
Validity
Objectivity -good; direct observation
Precision +/- ; open to interpretation
+/- some diseases are not detectable on physical exam.
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Diagnostic Studies:Diagnostic Studies:
Objective
Validity
usually free from interpretation errors
some diseases do not produce measurable changes
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The Science of Medicine
Units of observation
Quantities of measurement
Instrument for obtaining measurement
Signs and symptoms
Words and sometimes numbers
collecting the database:
You
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Clinician Characteristics
ValidReliable
– Objective– Precise– Reproducible
Discriminatory– Sensitive– Specific
qualities of a useful measuring tool:
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ValidValid
Appropriate to the problem
does the interviewer have a high enough index of suspicion to
consider the possibility that a problem may exist
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Objectivity:Objectivity:
Removing one's own beliefs, prejudices, and preconceptions from observations.
Precision:Precision:Using units of measurement (words) that are unambiguous and sufficiently detailed to indicate the real data.
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Sensitivity:Sensitivity:
ability to pick-up or detect real disease
ability to rule-out disease in normal people.
Specificity:Specificity:
Discrimination:Discrimination:
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Reliability:Reliability:the ability to get the same result
on repeated measures (reproducibility)
the ability of different observers (interviewers) to get the same results.
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“… interviewing skills that maximize objectivity and precision produce more accurate data and reduce the rate of false positive and false negative
histories.”
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One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.
Francis Peabody 1923
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More mistakes are made in medicine by people who don't care than by people who don't know.
Allen Gregg
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