Diagnosis is the process of identifying the nature of an illness by examining the symptoms and other factors. It is the first step towards determining appropriate treatment methods and prognosis. Several factors influence the process of diagnosis. With ever-evolving medical technology around us, diagnostics is getting improved day by day. The use of sophisticated diagnostic tools is a significant aspect that has an impinge on the process. Diagnostic tools are necessary to resolve any uncertainty about symptoms and organize the set of symptoms into manageable ones.
This does not mean that a set of sophisticated tools control the process. Diagnosis is a situated action. The ways of approaching the tools, interpreting the results, and many other factors decide the process. Different clinicians carry out the procedure differently. Here’s an example of CT scanning. In his book about CT Suite published in 2008, Barry Saunders, faculty of social medicine at the UNC school of medicine, has suggested that the images generated through CT scanning do not represent knowledge or evidence in and of themselves, but rather the complex of practices known as ‘reading’ is required to form and shape them into diagnostic evidence.
Evidence-based medicine is a plausible solution to the problem of practice variation. Providing clinicians with comprehensive evidence on specific clinical questions will ensure that they deliver optimal services. Medical organizations across the globe release regular instructions for diagnosis ad treatment. The coronavirus diagnosis instructions of the Food and Drug Administration USA is an example. aThe National Institute for Health and Care Excellence (NICE), UK, gives specific instructions on diagnosing and treating patients with various conditions. Evidence-based medicine sounds ideal for all its merits. However, there are several practical barriers to it.
Lack of Information – The absence of high-quality evidence reduces the possibility of making strong recommendations about practice. Unless there is a solid and comprehensive database, a standard diagnosis method cannot be suggested.
Cookbook Medicine – One major criticism that evidence-based medicine faces are the possibility of undermining clinical autonomy, discretion, and professional judgment. Fitting in local practices and information might be necessary for diagnosis.
Diagnostic Tools of Uncertain Clinical Utility – Approaches
There are different opinions and approaches regarding the use of diagnostic tools whose clinical utility has not yet been proven. While some believe that a test is necessary, no matter what, others believe that discretion and judgment can avoid tests.
Seeking Evidence – Some clinicians believe in the idea of ‘leaving no stone unturned’ and seeking all the available evidence. The results from a diagnostic tool could lead to a re-evaluation of the diagnosis. This will consequently help in determining the most appropriate treatment option. Confirming the results again before making decisions is considered significant.
Too Many Tests? – Some clinicians believe in using their clinical judgment to avoid tests, if possible. Exposing people to complicated tests, adding to their stress and panic, is seen as an unnecessary act. Moreover, unwanted experiments can result in the wastage of healthcare resources.
Changing practice is not easy. Studies on antibiotics prescription have shown that. A future threat of antibiotic resistance did not stop hospital-based clinicians from prescribing them. Protection of patients, reputation, peer practices and several other factors influenced their decision. The decision to use a diagnostic tool cannot be understood in black and white. It is a complex process where several factors come in. Clinical discretion, experience, and judgments are highly valued. However, it does not mean that a standardized diagnostic method is unnecessary or impossible. With the advancement in technology and the availability of high-quality evidence, we can look forward to creating standard guidelines that can help in precise diagnosis. Above all, the readiness of the patient should decide the process. The process of diagnosis should start and end with a clinician-patient dialogue.