The term ‘diagnostic process’, according to many of doctors, impoverishes the entire range of problems faced by the patient at the very beginning of the conversation with the doctor. Seasoned experts say that making a diagnosis is a creative process, as a rule, does not fit into the standard scheme. As there are no two identical doctors, and no two patients with identical conditions and problems, the spectrum of diagnostic methods aimed at figuring out the clinical picture in patients suffering from certain nosological forms of the disease is very wide in experienced, qualified and truly professional doctors (in young doctors, this spectrum is more narrow, but it could be more schematic).
Despite the fact that healing – is not so much a craft as an art of action by the doctor the term ‘diagnostic technology’ is oftentimes used in regard to diagnostic process as the work of a conveyor for the production of diagnostic services, at the inlet of which an unknown object is supplied, while on the output this image is filled with volume and content. The technological approach allows the physician to present architecture of the affected organs and systems of the patient causal connection between the relationship of the disease and impaired function of complex biological systems in the patient. This approach is also oftentimes used in legal practice according to Steve Duarte, medical negligence solicitors representative with years of experience under the belt.
By itself, the process of diagnosis of diseases consists of several stages:
- evaluation of signs and symptoms;
- initial diagnosis;
- differential diagnosis;
- clinical diagnosis.
The first stage of diagnosis is an assessment of signs and symptoms, starting from the first minute with a patient-doctor relationship. The physician should be prepared for anything, because she may potentially deal with any disease or problem under any circumstances. In this situation, the doctor usually focuses on the main (leading) patient’s complaint, which subsequently serves as the core of the entire diagnostic process and the evaluation of symptoms becomes the basis for the preliminary diagnosis. In the first stage the causes of medical errors are the following:
- failure to recognise the leading complaint and the true purposes of the visit;
- inability to clearly define the nature of the identified symptoms and complaints;
- inability to critically evaluate the reliability of the information to identify and discard leading and additional circumstances;
- underestimation of the nonverbal information;
- unwillingness of revaluation of leading complaints significance, replacing it with another cause in the process of assessment.
The actual practice of the medical examination shows that in the first stage of diagnosis the largest number of errors is made. And the fact of making a wrong decision could be devastating – in some countries (e.g. Germany), clinical negligence under certain circumstances the limitation period lasts for 3 years. So potentially, making a failure in one of the most complicated stages (the initial one) the doctor risks to get penalised if, let’s say, the undetected issue becomes evident and what is worse, becomes the reason for another, more complicated issue.