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The Diagnostic Process

When you see a physician for problems not previously diagnosed, the first thing they’ll want you to do is describe, in your own words, what’s bothering you. Depending on your circumstances, they’ll conduct some combination of a physical examination of your body (poking, prodding, looking, listening, etc) and an interview.

During the interview, you may be asked questions about:

  • The history of your present illness/symptoms. How long you’ve had them, have they changed over time. Intensity of the symptoms over time, etc.
  • Other current and past medical conditions
  • Current and past medications
  • Current and past allergies
  • Family medical history
  • Social history and environmental conditions. Your habits, living conditions, etc.

At the conclusion of your physical exam and interview, they will generally have a pretty good idea of your diagnosis and may order one or more diagnostic tests (usually lab or imaging tests) to either confirm the diagnosis or rule out alternative diagnosis.

Understand that the physical exam, interview, and diagnostic tests are almost always a ‘just enough’ subset based on your current conditions, and are a usually a small fraction of completely comprehensive physical exam, interview questions, and available diagnostic tests.

Even after the most comprehensive diagnostic process, some uncertainty may still exist in the mind of your physician. Depending on the circumstances, they may or may not share this uncertainty with you.   After completing their interview, physical exam, and possibly some diagnostic tests, you may get one of several different presentations back from your physician.

The most candid …

“Mrs. Smith, after reviewing your symptoms I’m still a bit uncertain as what may be most effective. It could be one of three possible problems. We can proceed in one of several ways, but I suggest that our first step be to do x.  But if x isn’t successful, then we’ll move on and try y. How do you feel about that?”

Under other circumstances, you may hear a less candid presentation, but still in a confident and convincing tone …

“Mrs. Smith, after reviewing your symptoms I’m ready to discuss your options. We can proceed in one of several ways, but I suggest that our first step be to do x. How do you feel about that?”

Your physician is not necessarily being deceptive with this second presentation. Why? Because your mind has a powerful role in helping you get better, and if you believe that what you’re doing will help you feel better, you have a good chance in succeeding even in the face of an uncertain relationship between cause and cure. This is known as the placebo effect. In blinded clinical studies, patients with similar diagnosis are broken into separate groups with some getting an actual treatment and some getting a placebo, which is a harmless but ‘fake’ treatment. Neither group knows what they’re actually receiving. Some patients receiving the placebo actually get better, despite the absence of a physiological reason. They get better because they believe they’re getting attention and care and they’re supposed to get better.   This same explanation can be applied to some of our traditional, family treatments that have no grounding in physiology. Grandma always said that if you had a sore throat, her special soup/salve/potion would fix it. So she prepares her special treatment and administers it, and we feel better. Is it important whether or not there was underlying cause and effect? Or is it just important that you feel better?

But it’s also important that you consider the potentially significant ramifications of your treatment choices in the face of uncertainty. If, for example, you’re dealing with an allergic condition for which the exact treatment is uncertain, but the options have about the same chances for success and adverse side effects and about the same out of pocket costs, then the difference between the first and second approach may not have a significant impact – positive or negative – on either your progress toward treatment goals or your out of pocket expense. You may want to know about the uncertainty, or you may respond better to the placebo effect.

If, on the other hand, you’re dealing with something like uncertainty over the cause of lower back pain and the treatment options have significantly different costs and adverse effects for uncertain positive outcomes, you need to know this before making your decision. And you need to understand that our existing healthcare ecosystem has a bias toward radical intervention and overestimating possible/likely positive outcomes and understating possible/likely negative outcomes. And a conscious disregard for the either the total expense or the out of pocket expense to the patient. Pile on top of all of that the natural bias of orthopedic surgeons to favor a recommendation of a surgical solution over less invasive physical or medical management treatments, and you begin to appreciate how the tide may carry you someplace you do not want to go.

 

Remember:  We coach, support, educate, and empower.  We illuminate options you may not have known you had.  But we don't decide what's right for you in your unique circumstances; only you can do that.  And we don't provide medical, financial, or legal advice; nor do we replace the valuable counsel of those who do.