Diagnosis
การวินิจฉัยโรค
Diagnosis, the two meaning
• 1. The name of the patient s disease the diagnosis or a diagnosis and the diagnoses or diagnoses)
• 2. The act of searching for or determining the patient s disease ,refer to making a diagnosis ,diagnostic process, procedure
Logic and diagnosis
Diagnostic reasoning
• Disease names, essential diagnostic labels
• The name of a disease serves as a catchword for writings on its description, definition, etiology, diagnostic feature, prognosis and treatment
Certainty of the diagnosis
• Degrees of certainty is UNCERTAINTY
• Diagnose probable or question mark
Other
• Preliminary diagnosis
• Diagnostic impression
• Tentative diagnosis
• Working diagnosis
• Provisional diagnosis
• Probable diagnosis
• Other
• a primary diagnosis
• a secondary diagnosis
• Other
• admission diagnosis
• discharge diagnosis
• Other
• Final diagnosis
• definite diagnosis
• Other
• Anatomical diagnosis
• pathological diagnosis
The diagnosis four steps in examination
• Diagnostic four step
• Step1. Acquisition of facts
• Step2. Evaluation of facts
• Step3. Listing of hypothesis
• Step4. Choosing Between hypotheses (the differential diagnosis)
•
Prerequisites for diagnosis
1. Acquisitions from preclinical course
Gross anatomy
Physiology
Pathology
2. Acquisitions from clinical courses and experience.
Methodology of clinical examination
Formulating and memorizing lists of symptoms and signs of disease
3. Acquisitions of skill from practice
History taking
Inspection
Palpation
Percussion
Auscultation
The diagnostic examination
Clue-search in four compartments
• 1.history taking where clue are symptom
• 2.physical examination where clues are physical sign
• 3.Laboratory examination
• 4.Special anatomical and physiological examination
Test of diagnosis
• 1.Parsimony
• 2.Chronology
• 3.Degree of sickness
• 4.Prognosis
• 5.Therapeutic test
• 6.Selection of diagnostic test
• 7.Rare disease
Deferred diagnosis
• 1.Repeat the history taking and the physical examination
• 2.Repeat laboratory test
• 3.Deferral diagnosis
Decision hypothesis
• Medical decision making
• Medical logic
• Clinical problem solving
• branching diagnosis CPG
• matching diagnosis
Model of the clinical reasoning process
• Step1 Determine the patient question
• Step 2 Searches for clues
• Step 3 Develop hypotheses
Clinical problem solving
• Strategies for clinical reasoning
• 1. Reasoning with Reductions
• 2. Reasoning with Problems individually
• 3. Reasoning with Time
• 4. Reasoning with Organ system
• 5. Reasoning with Organization
• 6. Reasoning with Probability
• 7. Reasoning with Causality
• 8. Reasoning with Systems theory
• 9. Reasoning with Induction and Deduction
• 10. Reasoning with Incongruities
• 11. Reasoning with Analogy
• 12. Reasoning with The physician-patient relationship
Clinical problem solving
• Inductive reasoning (In practice)
• ×
• เป็นการตั้งสมมุติฐานจากประสบการณ์ แล้วพิสูจน์สมมุติฐาน
• Deductive reasoning (In study)
• Ø
• เป็นการเก็บรวบรวมข้อมูล แล้วหาขอสรุปที่เหมาะสมที่สุ
Use of statistics in diagnostication
• Prevalence
• Common disease
• Common disease most commonly occur
• Rare disease
• Rare disease occurred rarely
