Often times, patients are confused as to how a health care provider may derive at an accurate diagnosis in order to render effective treatment, management, and give patients an idea regarding whether or not the patient will get better or not (prognosis).
Patients should remember this simple equation:
symptoms+/- risks +/- signs + evidential support (lab tests, imaging studies, etc)
= Wellness or Diagnosis of illness/disease
The principle goal of medical evaluation is to derive at an accurate diagnosis of disease and/or illness.
So, when a patient sits down to chat with the health care provider, an interview regarding the patient’s health ensues.
The History of Present Illness (Symptoms):
-The health care provider asks a series of questions pertaining to the present illness, often initiated by “Chief of Complaint,” ie. “what caused you to want to see the health care provider?”
-Time or sequence of events pertaining to the “chief complaint.” When did this problem start? Was there an initiating event that caused it? Do you think the problem is getting better or worse? What makes it better, or what makes it worse? Are there any other symptoms that you can associate with this problem, and if so, what makes those symptoms better or worse? Are you having any other conditions that may be associated with the symptoms? Are there other concerns regarding your health and your current condition that you would like to address?
Past Medical/Surgical History (Risks)):
-Previous Medical Evaluation/Diagnosis: Do you have any other medical conditions that have previously been diagnosed by a health care provider? What are they? Have you had any surgeries done before? What are those surgeries that you have had done in the past?
Medication List (Risks):
Are you currently taking medications for treatment of specific diseases? What are they?
Allergy List (Risks):
Are you allergic to certain medications? What are the names of those medications for which you are allergic? What sort of symptoms do you associate with the medication allergy?
Social History (Risks):
Do you smoke or use tobacco or alcohol, or any other illicit drugs? If so, how long have you used tobacco, or how much alcohol do you consume within a week, for example?
Family History (Risks):
Are your parents currently alive and well? Do they have any medical conditions for which they are being treated? If your parents are deceased, what was the cause of death?
Based on the answers to the above questions, the health care provider generally has an idea regarding potential diagnosis, or diagnoses, as this is known as “A differential Diagnosis.” The next step is The Physical Examination.”
The Physical Examination (efforts to detect signs of disease):
A general physical examination would include an objective analysis of all the organ systems, starting from a general health assessment, i.e. age appearance, physical appearance, gait, presence or absence of acute distress, orientation to time, person, place or situation, etc. This is followed by assessment of vital signs,i.e. weight, height, temperature, blood pressure, pulse rate, and respiration rate. A detailed physical evaluation of all organ systems is then initiated, starting from Head and Neck, to Chest, then Abdomen; then Pelvis, Extremities, and finally the Neurological Assessment (which is often included during the performance of other parts of the physical examination)
At this point, specific diagnosis or diagnoses can be determined preliminarily. A plan of action is then discussed with the patient with regards to gathering supportive, confirmatory evidence for disease or illness based on the above clinical assessment. This would include the following:
Clinical or Pathophysiological Evaluation (ASE) (Evidential Support for Illness/Disease):
collecting blood/body fluid/tissue/cellular samples for laboratory testing
Special Clinical Studies, i.e. cardiac stress, ECHO, EKG, EMG, Pulmonary function test (PFT), Endoscopy/Colonoscopy, bronchoscopy, colposcopy, cystoscopy, etc
The Anatomic or Structural Evaluation for Disease (Evidential Support for Illness/Disease):
-ordering imaging studies like X-rays, CT scans, MRI, bone scans, Mammogram, Ultrasound, etc
-Procedures, such as skin biopsy, or Fine Needle Aspiration, or Pap smear, Peripheral Blood Smear Review, etc
Based on the findings from the above collective studies, A FINAL DIAGNOSIS AND/OR DIAGNOSES ARE DETERMINED, and the following takes place concluding the medical evaluation:
-Plan of care, i.e. medications or surgeries
-Instructions and recommendations for life-style changes as appropriate for healthy living, recovery from disease or illness, maintaining acceptable functional course with stable chronic disease/illness, or preparing the patient for end of life process.
-Instructions and reading materials for patients to become Informed about their diagnoses and CARE-PLAN (we recommend that our patients get information from websites such as: MayoClinic; WebMD; and Medscape, for example)
-Recommendation for referral regarding specialty medical care and SECOND OPINION.
-Opened Question/Answer Session between Patient and Doctor
Preventative Care and Healthy Care Maintenance:
Now imagine, if the patients come in already prepared to answer the above questions, then the medical interview could be as short as 10-15 minutes, and the patients could be on their way to an accurate diagnosis, treatment, and management. More importantly, patients without symptoms, should seek medical diagnosis before symptoms develop, as in complications from diabetes, or high blood pressure, or heart disease, or stroke,or HIV, or cancer, etc. Typically when a patient presents with symptoms, the diagnosis of certain types of diseases is usually in the advanced stages and effective treatment becomes limited. Thus, we at MDC stress PREVENTATIVE CARE AND MAINTENANCE HEALTHY CARE, to avoid expensive, typically ineffective/inefficient sick care.
Consider preventing diseases through routine healthy check, and not just through dieting and exercising which are helpful but at no means all inclusive in the PREVENTION of major diseases, particularly as it relates to genetic, congenital, infectious, and degenerative diseases, for example.
Empowering Patients for Better Health-Care!
The Pathologist, as the common expression among other physicians, “The doctor that is knowledgeable about many diseases, performs many investigative diagnostic procedures, and a member of the treatment/management team, BUT TOO LATE.” We at MDC-Atlanta, are committed to performing the medical tasks BEFORE IT IS TOO LATE, by partnering and communicating with patients DIRECTLY, as well as providing treatment and management of certain illnesses and/or diseases!
