Planning Diagnostic Examination

Two types of diagnostic examination of the patient are distinguished. One of them consists in the following. As suggested by the main or a more vivid symptom, e.g. cardiac pain, jaundice, cough, vomiting, etc., the physician examines the corresponding organs or functions. He arrives at a diagnosis from the symptom through a concise additional examination. For example, if a patient complains of right iliac pain, and palpation in this region is painful a diagnosis of appendicitis may be established (provided other signs are revealed). This method is often used for a quick diagnosis in emergency cases. But this method is effective only in simple cases and is fraught with danger of erroneous diagnosis, because the patient's general condition and all the systems of his body are not examined thoroughly. Moreover, the examination is carried out without any plan and method and the diagnosis is thus incomplete and abstract.

The other approach can be called methodical and is more complicated. All the organs and systems of the patient are examined following a certain plan. Clinical anatomy (pathological anatomy included), physiology, con­stitution (including the body make-up, functional performance, type of the nervous system, reactivity, which is important for individual diag­nosis), separate signs of the disease are studied, i.e. a physician car­ries out an analysis the purpose of which is to assess the condition of the body as a whole. This can be done by the synthesis of the findings. The study of the patient is not, however, completed at this stage. Additio­nal laboratory and instrumental studies should be carried out on the basis of the discovered symptom or syndrome in order to verify the lesion or the affected organ and to reveal the essence of the pathology, the symptoms are compared to establish connections that may exist bet­ween them, and finally all findings are put together to arrive at a final diagnosis.

Even if a diagnosis can be established at first sight (e.g. exophthalmic goitre, a wound, erysipelas, heart defect, etc.), a methodical study of the patient is also necessary. This complicated examination should end by establishing a diagnosis, not only a correct but also detailed enough in order to suggest the proper choice of therapy.

It should be noted that the diagnosis of the disease and of the patient cannot be regarded as a constant formula since it changes with the develop­ment of the disease. Under the effect of treatment or during development of complications, the condition of the patient can change markedly, and the diagnosis and prognosis will change accordingly. The diagnostic study of the patient's condition is thus continued during the entire period of

clinical observation and treatment. This is the diagnosis of the course of the disease and also verification of the initial diagnosis.

The diagnostication process can be divided schematically into iden­tification of the disease and the study of the patient during the course of the treatment. The diagnostic conclusion covering the entire period of observation and treatment is summarized in epicrisis.