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Diagnosis isExamination,InspectionAnd use the information obtained thereDoctorThe expert, such as, is to judge the patient's health condition and illness condition.During the diagnosisinferenceThere is a stage to do.ThereforeMisdiagnosisCan occur.
Diagnosis ispatientIt is said that it has already started from the stage when it started to enter the door (or curtain) of the examination room, and such education and training are often carried out in medical schools.The doctor tells the patient how the patient looks (posture, walking (walking speed, stride), limb movement, sitting on the chair) from the time the patient enters the examination room until he / she sits in the chair in front of him. Also, whether the facial expression etc. is normal or abnormal, etc.) casuallyObservationTo do.
(Patients are also aware of this from this stage) Patients complain about physical symptoms (Complaints) While listening (interview), (againChronic conditionOrally ask for history or pastMedical chartDescribed inMedical history-PrescriptionObserve the patient's physical condition in detail and carefully (while checking the history etc.).
The most common (and introductory) tests of modern medicine are (1)blood pressureMeasurement, (2)pulseCheck the number, (3)StethoscopeでShinonListen to. (These are very easy to do and are widely used because they often provide important information.[Note 1] (The number of patients is large,waiting roomWhen it is crowded, in order to improve efficiency, it may be necessary to listen to the complaints from the patient in parallel while doing the above three things. )AlsoTongue depressorWhile holding the tongue withthroatI often check the depths of.
The doctor makes a tentative reasoning (in the doctor's mind, somehypothesisIf necessary, a new examination or additional test will be conducted to narrow down the hypothesis or to verify the validity of a particular hypothesis.
The tests performed at this stage are, for exampleBlood test,urinalysis,Stool examination,electro-cardiogram,echo, Saliva test, breath test,Quasi-tendon reflexPercussion etc.AlsoRoentgenInspection and in modern developed countriesCT-MRIInspections may be performed.
If it is a common symptom, it may be easy to make a final decision.By the time of receiving medical education, doctors have already been educated so that they can recall disease name candidates from the symptoms if they are common symptoms, and immediately list them as candidates and verify them (in their hearts).Database-like literature has also been published to search for candidate illnesses by symptom, and doctors often have it on the desk shelves in the doctor's office, which can help with relatively rare symptoms. ..However, if you find a combination of unusual symptoms or symptoms that are unlikely to occur normally, you may have to make complicated inferences.Diagnosis can, in some cases, be the task of inferring and estimating hidden or past causes from fragmentary information (like detective novel detectives or CSI investigators).Therefore, the diagnosis may not go straight, and the hypothesis (which the doctor strongly supported in the middle of the heart) may be judged to be wrong and must be abandoned. In order to verify, the work of asking the patient a special question, examining the answer, or verifying the hypothesis by adding a new test, etc., is a complicated process many times. May be repeated.
Diagnosis can be erroneous because it involves inference and can be erroneous.MisdiagnosisMisdiagnosisIs called.Various surveys have revealed that about 10-30% of the diagnoses made by doctors are misdiagnosis (numbers vary from survey to survey).
In addition, the diagnosis is made because the symptom group is not uniquely linked to a specific disease, or because there are few cases of similar symptom groups, there is not enough knowledge to identify it as a single disease, and there is no concept of the disease. In some cases, it cannot be attached.In addition, even in modern science, many mental and physical abnormalities are objectively agnostic, and it is often difficult to make a diagnosis corresponding to subjective abnormalities.
In the first place, many mental and physical abnormalities exist in a gradation pattern without a boundary between "normal" and "abnormal", so "diagnosis" is not "finding" the presence or absence of abnormalities, but "the name of the disease at the doctor's responsibility". In order to confirm and start treatment, we will draw a line in the gray zone and decide to judge it as abnormal. "The "diagnostic criteria" that exist in many diseases are created in this way and therefore change from time to time due to the prognosis and therapeutic potential of medical advances, or social influences such as health economics and policies.Therefore, what is diagnosed according to the diagnostic criteria is not necessarily an objective, absolute, fixed indicator of normality or abnormality.
- Awarely and objectively "sickWhat is the difference between those who are considered "is" and those who are not?
- The difference is the samesymptomIs it common among those who present?
I have unknowingly made the decision, named the disease and searched for a cure.But most of them had to rely heavily on the oral traditions of their predecessors and their own experiences.
ModernTo enter the,EuropeThen.Academic magazineHas spread to the world of medicine, allowing many doctors to share their experiences.On the other hand,19st centuryFrom the end20st centuryOverX-ray photograph,microscopeIncludingInnovation"The difference between a sick patient and a non-sick patient"発 見The means to do it has expanded dramatically.Thus medicinenatural ScienceIt can be said that he has joined the ranks of.
However, as a harmful effect, variousInspectionCaptive of normal / abnormal values, and thus of the patientQuality of lifeCriticism has come to be cast that treatment may be prioritized over normalization of test values.
As a reflection on this, nowProblem-oriented(Problem-oriented: PO) Clinical diagnosis is becoming widespread at universities and teaching hospitals.is this1968 Advocated by US doctor Weed, first and foremost, treat patient complaints as the most important information.
- S (Subjective): Patient's complaint (but should not be taken literally).
- O (Objective): Objective findings.First, the patient's condition is grasped by making full use of the five senses, and the results of various tests are also entered.
- A (Assessment): Medical professional's interpretation of the above.
- P (Plan): What to do in the future based on A.
S and O must be written without the subjectivity of the medical staff.
The advantage of this method is
- Patient problems can be identified by writing medical records.
- Know what is the biggest problem and what treatment to prioritize.
- It is easy to share information and judgments with other medical professionals.
That is the point.
Clinical decision analysis
Until now, there has been a consciousness among medical professionals that there is only the best medical intervention (testing and treatment) means for a certain disease, so the judgment process including the decision of treatment means is called "diagnosis". There was an implicit understanding.WhereSherlock Holmes detective novelIs established.
But,Evidence-based medicineShows onlyProbability theoryIt's just a typical number.There are also emergencies in which treatment must begin before a diagnosis can be made.Furthermore, in such an urgent situation,Life extension treatmentThe patient's values of wanting or rejecting the patient must also be emphasized.
Among these uncertainties, the PROACTIVE model is proposed by Hunick and Glasziou to establish a methodology for value judgment...Here, all factors from the problem of medical resources to the values of patients are taken into consideration, and the calculation that can be quantified and automated by probability theory is left to the computer, and the final value judgment is made.
machineOr some kindsystem AnomalyIf there is an abnormality, identify the type of abnormality and perform some intervention (RepairThe work of determining whether or not) is necessary is called diagnosis.Embedded systemSuch ascomputersMany machines equipped with a self-diagnosis function (hard disk OfSMART,Vehicle OfOn-board diagnosticsIt is similar to medicine in that it is human beings who make the final judgment (whether it is really abnormal or repair).
- ^ またJapanese medicalThen, since it is a necessary condition for the medical side to claim the price of "examination" from the health insurance association etc., when the doctor sits in the chair in front of the patient in the examination room, what is it? In any case, there is also the aspect of measuring blood pressure, checking pulse rate, and checking heart sounds.
- ^ Written by H. Harold Friedman Translated by Shigeaki Hinohara "PO Clinical Diagnosis Manual" Medical Science International ISBN-4 89592-294-4
- ^ Myriam Hunink, Paul Glasziou, Translated by Jiya Fukui, "Decision Science for Medical Care and Healthcare: Integration of Evidence and Value Judgment," Ishiyaku Publications ISBN-4 263-20554-5
- Medical treatment
- Evidence-based medicine
- Medical checkup
- Home health checkup
- Health at the time of diagnosis school
- General Clinic Doctor G ――Variety program in quiz format up to correct diagnosis
- --Industry terminology used in American medical practice.Diagnosing a rare, astonishing, or sensational illness with similar symptoms to a common illness.