Lesson 2 Medical Diagnosis

Text: Medical Diagnosis

Grammar: Reported Speech

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Active Vocabulary

to discern homeostasis psychology departure auscultation to tap percussion treadmill ambulation fecal pneumonia cough sputum fever chills

[dI'sE:n] ["hqVmIqV'steIsIs] [saI'kPlqGI] [dI'pRCq] ["Lskql'teISqn] [txp] [pq'kASqn] ['tredmIl] ["xmbjq'leISn] ['fJkql] [njH'mqVnIq] [kPf] ['spjHtqm] ['fJvq] [CIlz]

розрізняти, розпізнавати гомеостаз психологія відхилення, відхід, відступ вислуховування (хворого) вистукувати, стукати перкусія, вистукування тупчак, бігова доріжка ходьба; здатність пересуватися після операції фекальний запалення легень, пневмонія кашель мокротиння жар, гарячка; лихоманка озноб

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Read the following text.

Medical Diagnosis

The word diagnosis is derived through Latin from the Greek word διαγιγνώσκειν, meaning “to discern or distinguish”. Medical diagnosis refers to the process of attempting to determine and identify a possible disease or disorder and the opinion reached by this process.

A physician’s job is to know the human body and its functions in terms of normality (homeostasis). The four cornerstones of diagnostic medicine, each essential for understanding homeostasis, are: anatomy, physiology, pathology and psychology. Once the physician knows what is normal and can measure the patient’s current condition against those norms, she or he can then determine the patient’s particular departure from homeostasis and the degree of departure. This is called the diagnosis.

Physicians usually begin the diagnostic process by observing the patient for specific signs and symptoms and by taking a specific history. These allow the physician to perform a specific physical examination and order specific diagnostic imaging. The provider usually formulates a “short list” of likely diagnoses and may obtain further testing to confirm or rule-out competing diagnoses before providing treatment.

Medical tests commonly performed are: measuring blood pressure, checking the pulse rate, listening with a stethoscope (auscultation), tapping a part of the body (percussion), performance tests such as treadmill ambulation, vital capacity, balance tests, pathological and neurological tests such as reflexes, sensation and muscle testing, urine tests, fecal tests, saliva tests, blood tests, medical imaging, electrocardiogram, hydrogen breath test and occasionally biopsy.

Diagnosis and etiology are often used synonymously, especially since germ theory began to link causative agents with disease. For instance, a common disorder such as pneumonia was used as a diagnosis, and the disease was defined as a complex of many symptoms consisting of cough, sputum production, fever and chills. Later, as the actual cause was assigned to micro-organisms, the term diagnosis included the causality, e.g., pneumococcal pneumonia, suggesting not only a spectrum of symptoms but also a cause for the symptoms.

There are a number of techniques to obtain a correct diagnosis:

• exhaustive method – every possible question is asked and all possible data are collected;

• algorithmic method – the provider follows the steps of a proven strategy;

• pattern-recognition method – the provider uses experience to recognise a pattern of clinical characteristics;

• differential diagnosis – the provider uses the hypothetico-deductive method, a systematic, problem-focused method of inquiry.

The advanced clinician uses a combination of the pattern-recognition and hypothetico-deductive approaches.

If the presence of some medical conditions cannot be established with complete confidence from examination or testing, diagnosis is then made by elimination of other reasonable possibilities and is referred to as the diagnosis of exclusion.

If the provider is uncertain of the condition present, further medical tests are performed to confirm or disprove the diagnosis. Consultations with other specialists in the field may be sought. If unexpected findings are made during this process, the initial hypothesis may be ruled out and the

provider must then consider other hypotheses.

Despite all of these complexities, most patient consultations are relatively brief, because many diseases are obvious, or the provider’s experience may enable him or her to recognize the condition quickly. Another factor is that the decision tree used for most diagnostic hypothesis testing is relatively short.

Once the provider has completed the diagnosis, the prognosis is explained to the patient and a treatment plan is proposed which may include therapy and follow-up consultations and tests to monitor the condition and the progress of the treatment, if needed, usually according to the medical guidelines provided by the medical field on the treatment of the particular illness.

A failure to respond to treatments that would normally work may indicate a need for review of the diagnosis.

Answer the following questions on the text.

1. What does the medical term “diagnosis” mean?

2. What are the four cornerstones of diagnostic medicine?

3. Physicians usually begin the diagnostic process by observing the patient for specific signs and symptoms and by taking a specific history, don’t they?

4. What most commonly performed diagnostic tests do you know?

5. Why are diagnosis and etiology often used synonymously?

6. What techniques for obtaining a correct diagnosis do you know?

7. What approaches to obtain a diagnosis does the advanced clinician usually use?

8. Why may the initial hypothesis be ruled out?

9. Why are most patient consultations relatively brief?

10. In what case must the diagnosis be reviewed?

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