When a diagnosis is accurate and made in time, a patient has the best opportunity for a positive health outcome. But, sometimes the diagnosis can be difficult to determine and to make a clinical decision, some rules must be followed.
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The first person to come up with symptoms is the patient. The is obvious, but when there is so much work, it is easy to shut down the patient and start with tests right away, hopeing we'll find the diagnosis faster, without spending time talking with the patient. This is wrong because setting a diagnosis is an iterative process in which the cooperation with the patient is very important.
It starts with an interview, from basic things like "Where do you feel the pain?" to questions about the clinical history, family health issues, and living environment.
That process of information gathering may be straightforward, but it can also be difficult because of various reasons and there could be a lot of back and forth before we fully understand the patient's situation.
A talk with patient's family is also important, not just in case when the patient can't talk, but she may choose to withheld some information of it may be the case that family see things that the patient doesn't or don't want to admit.
When we have all information we can get, that may lead us to a single diagnosis, or to a list of them, which is called a differential diagnosis. In everyday life, the doctor considers more than one diagnosis and work from there, trying to confirm what can it be.
The working diagnosis must be shared with the patient, and during every step of the way toward the final diagnosis, the doctor must communicate with the patient.
First, the patient has the right to know, and second, she may come with some useful information during the process that may help us in setting the diagnosis.
As a rule of thumb, when we come to one or two diagnosis, we will conduct appropriate test to see which one is the right one. Here we must be careful and avoid test "just in case."
If there is no reasonable chance that the test will give us useful data, we shouldn't do it. If it is about an invasive test, we must carefully consider all options and talk to the patient and explain why she needs to undergo such an unpleasant test.
There are some cases when tests are necessary, for example the confirmation of some diseases require a blood picture, but there is a tendency in some developing countries that recently gained the technology to make test "just to be sure."
This is a very wrong approach because if the doctor is sure what it is all about, there is no need for a patient to undergo, say, X-ray screening just to confirm what's already known.
Let's say we have a patient who suffers from abdominal pain, weight loss, low blood sugar (even fainting), extreme fatigue, and salt craving. If you look at it separately, those are common symptoms that can mean anything. Look a bit closer and it may remind you on hypoglycemia.
But if you look again, Addison's disease, a rare hormonal disorder, become the suspect No. 1.
This is an example, although a simplified one, what your doctor is facing trying to find out what's wrong with you, before ordering some tests to confirm the original idea.
Now, with all that's going on, how the patient can tell her doctor is on the right track to the right diagnosis? It's easy to say just by following the doctor's behavior.
First, if you doctor is lecturing you about bad lifestyle, criticize the way you care about yourself, and acting like he is talking to a six years old - find yourself a new doctor. Of course, it's on the doctor to say if he spots some unhealthy habit but it's not him to make you feel guilty.
Second, your doctor must be aware that your body is your responsibility, so every suggestion about healing should sound like "I think this is the best option for you," not "This is what we will do." The doctor can't control your life and can't force you to do anything, so he must respect your wishes even if they are not in line with his thinking.
Third, if you have questions or don't agree with, say, a proposed test, ask your doctor for an explanation. If you get it, decide what to do next, but if you don't get an explanation - or got the one full of medical jargon you can't understand - ask for another doctor.
While at that, you may say your doctor you want a second opinion any time. If the answer is "No need for that," this is not good. If your doctor is OK with that, that means he knows what he is doing and the chance is you may trust him. ■