Friday, April 16, 2010

MOAS-After reading Chapter 4, 5 & 6

What is meant by the term “differential diagnosis?” What is the benefit/drawback of this term?

Please respond by Tuesday, April 20th.


  1. Differential diagnosis is the term which describes the method that doctors use to determine the specific illness/issue afflicting a patient. Dr. Nolen describes making "two, three, four, or even more" diagnoses for a single problem, depending on the doctor's conversations and examinations with and of the patient. Though there are most certainly drawbacks and benefits to this method, I do believe that the benefits far outweigh the negatives. The major disadvantage of "differential diagnosis" is that a patient may have an illness or problem that is quite obvious, but instead of treating that patient for this seemingly obvious condition, you have to spend time determining other possible causes; this wastes time, as you could be treating the patient. However, as Dr. Nolen says, "no two patients are alike...and no two instances of disease are alike." If the patient's illness is not the obvious, most common answer, and you treat that condition without considering the other possibilities, you will be treating the patient for the wrong thing. By the time you make this realization, the patient could be in a very bad state, or even dead. To me, the choice to use this method is a choice between time and death. The doctor is free to choose which is more important; but for me, even at a ridiculously busy hospital like Bellevue, saving a life is always better than saving time. Dr. Nolen even states, "surgeons are wrong about 15 percent of the time, even in their diagnoses of such a 'simple' disease as appendicitis." This method of "differential diagnosis" can help save those 15 percent of patients who suffered from assumptions made about their cases.

  2. In the vast and important realm of medicine, "differential diagnosis," (as it is known to those in the know) is the term applied to the process by which physicians come to an intellectual conclusion which diagnosis a medical condition. Just like the SAT, it is a process of elimination that involves all of the possible diseases. It involves a scientific process of elimination that takes into account the results of lab tests, medical history, genetics, among other factors. The benefit of this system of determining the causes of an ailment is that the approach is methodical, and with proper care and circumstances a correct conclusion is reached. However the world is not perfect, humans are not perfect, doctors are humans, therefore, they make mistakes. To paraphrase a profound observation by the great Brett Miller himself, It sucks to die.

  3. Differential diagnosis is a process for diagnosing disease that involves the systematic elimination of (hopefully) all but one possible diagnosis. A doctor will start with a list of diseases that, in their various incarnations (as in many cases a single disease may manifest itself completely differently in different cases) resemble the symptoms the patient is suffering. Of course this system is has its problems.

    Especially rare diseases or rare strains of a commoner disease would be difficult to diagnose, since they might be dismissed as possibilities simply due to their rarity. It's may SEEM like it's never lupus, but hey, it only needs to be lupus once for a patient to die from it while you stomp around with a cane saying "It's NEVER LUPUS."

    Though it should be noted, as Brett mentioned, that there are cases where patients, strapped for time, may be hurt by the time it takes to consider all possibilities. Indeed, a Dr. Theodore Woodward put forth an aphorism that is widely known in medical circles, "When you hear hoofbeats behind you, don't expect to see a zebra." In most cases, the simplest answer is the correct one.

    However, the fact that there exists the medical term Zebra, which is a diagnosis that differentiates from the norm, shows that rarer diseases, lupus, for example, do happen. In addition, doctor's looking for a disease that fits all the symptoms a patient may fail because they do not remember, Hickam's dictum, a principle put forth by Dr. John Hickam, which states, "Patients can have as many diseases as they damn well please." An added complication of differential diagnosis is that you must account for the fact that your patient might have multiple diseases. Though it is true that it is complicated, without going through the steps of differential diagnosis, it is hugely probable that somebody is going to die from a disease that you misdiagnosed.

    Thus, Differential Diagnosis is a necessary, though complicated procedure.

    Also, it's never lupus until it is.

  4. Since the rise of modern medicine differential diagnosis has gained widespread use and popularity, yet it has remained largely ineffective and unnecessary. Differential diagnosis is the direct product of 'defensive medicine', a practice by which doctors under-treat and over-test a patient, in order to avoid a possible lawsuit. Since a doctor cannot be sued for doing nothing (except in a few cases), they risk less by standing dangerously idle than by making bold, and possibly life saving, interventions. To comment on the question raised by the wise Jacob Wilson, I feel that the recent health-care bill, for all the great and revolutionary strides it made, did not do enough to curb the practice of 'defensive medicine'. Differential diagnosis is a process which is used far too much, and can cause doctors to second-guess there initial findings, allowing the condition to grow far worse. For every life that is hurt by a misdiagnosis, there are ten that would be saved by a doctor's bold action; but that single life could cost the doctor his savings, if not his license. Although some of the fault lies with the doctors, the federal government should do far more to protect rights of the men and women who serve this nation's sick. With thirty million new patients arriving into the medical system in 2014, this nation will need more doctors. We need to provide an incentive for young men and women to join the relatively small ranks of medical professionals. The threat of being sued steers people off this noble calling, and the practice of defensive medicine slows the diagnosis of patients already being treated. In order to have an efficient and growing body of doctors the Federal government needs to step in to legally protect doctors - which will all but abolish 'differential diagnosis'. The Federal government must bring an end to this wanton inefficiency, at a time when efficiency is needed most.

  5. Differential diagnosis is a process used by doctors to consider a selection of possible diagnoses for a single patient case, in order to not eliminate possibilities. I would like to address Eli's argument by arguing for keeping the practice of differential diagnosis.

    First off, "The Making of a Surgeon" really only talks about one type of practical medicine in the medical world. Differential diagnosis is not necessary when treating physical injuries like cuts, muscle tears, broken bones, and skin burns. Since these types of injuries take up a large chunk of hospital doctor care, arguing that differential diagnosis slows down all doctors all the time is not true.

    Next, real-world medical practice is not Gregory House. Daring, bold actions don't always save the patient, and hidden symptoms and multiple diseases are a reality that doctors must face when diagnosing their patient. For example, a patient may come in experiencing a medium fever and muscle convulsions. A doctor not using differential diagnosis might write up the patient for chorea or low-grade epilepsy and refer the patient to another department. However, that patient may develop hydrophobia and hallucinations, and die 12 hours later from an untreated rabies bite. Keeping all possibilities in mind is essential to saving a greater amount of lives.

    Therefore, I believe an update to the healthcare system should make testing more efficient and allow for a less conservative approach to diagnosing a patient, but differential diagnosis should NOT be eliminated.

  6. Daniel said...

    I love how this term "differential diagnosis" going hand in hand with the picture of the "House M.D." cast above because it is the tool those fake doctors use every episode. Through the process of observing symptoms of and preforming tests on the patient, House's team is able to diagnose the patient using process of elimination. For instance, if a patient is exhibiting a symptom that is characteristic of both diseases A and B, but exhibits a symptom that is only characteristic of disease A, then through process of elimination, the doctor can only diagnose disease A. This method is very effective in dealing with both simple and complex cases, because it's the most systematic and efficient means of narrowing down the possible ailments a patient may have. However, the process may be too systematic and straightforward. If one were to completely adhere to differential diagnosis, he or she would completely overlook the human aspect of the patient's case. As we all know, everyone is unique in their own special way, and often people's bodies have different reactions to the same chemicals. If a doctor using differential diagnosis goes through the process completely oblivious to this fact, he or she could be lead astray from the path to the correct diagnosis. These advantages and perils of differential diagnosis have been portrayed very well on house over the last half decade.

  7. Karli said...

    1) As stated earlier, differential diagnosis is a systematic method used by doctors to attempt to diagnose a particular disease in a patient. I disagree with Eli- I feel that it is completely
    necessary. It is definitely better to double check and add some "just in case" prescriptions- -or at least thoughts- just in case the disease does indeed end up being something unexpected or rare. Take appendicitis for example.
    While it may not be extremely common, its symptoms are common among colds or flus. If a doctor were to simply take such symptoms to be
    the obvious answer of a flu and not even consider the possibility of appendicitis, it can have deadly results. The patient returns home
    with the prescription, satisfied. He takes the medicine and continues his day. Then twelve hours later, he feels an intense pain
    in his stomach and begins vomiting constantly. He assumes it to be simply the flu, as the trusted doctor told him he had, and doesn't
    want to return to the hospital simply because of a lack of time or money, or he just believes it's just what the doctor said. And so by the time he realizes that there is something really wrong, it may be too late. However, had the doctor considered appendicitis, he can simply warn the patient to come in immediately if he feels any severe abdominal pain. Such advice costs no money, and may very well save a life. Thus, differential diagnosis is absolutely vital for a
    patients health.

  8. Nolen refers to the medicinal field as "alive... as the patients [they] treat," and the practice of differential diagnosis is one of the many tools a doctor uses which is neither perfect or exact. However, it is critical in a proper diagnosis and prognosis of a patient. The beauty of the differential diagnosis is the maleability it gives to doctors. It increases their patient's chance at survival and, allows physicians to be wrong and right at the same time. Without differential diagnoses patients would have to undergo multiple ineffective, and often expensive, treatments.

    Because it is inaccurate in its design, the differential diagnosis has its drawbacks. Doctors often rely on it as a crutch by diagnosing several problems that are highly unlikely solely for the sake of looking professional. Gregory House M.D. defines this problem as the "surgeon valuing his work over his patient." The physician, in this case a doctor, needs to avoid looking foolish or unintelligent, and therefore makes claims that he knows are likely false to preserve his reputation. But the most lethal problem differential diagnosis presents is the chance of an allergic reaction in a patient to one of the many treatments. If a doctors diagnosis is incorrect and the proscribed medicine may cause an allergic reaction. House again exemplifies this problem with an anecdote about a patient suffering from a dog bite. The patient's lies to House and his team lead them to believe that the patient has been bitten by a snake. They treat him with an antivenin that causes an allergic reaction and he nearly dies.

    Differential diagnoses are a useful and necessary tool in the medicinal practice, but they should be used sparingly and only to better the patient and not to better the reputation of the doctor.

  9. Sasha said...

    Differential diagnosis is the process by which doctors rule out a myriad of illness that correspond to a set of symptoms in an effort to prevent a possibly fatal mis-diagnosis. I have to say that Mitchell (who I adore and respect deeply) totally stole my zebras analogy. My dad uses that expression all the time. So needless to say that Mitchell is cool. I think that differential diagnosis is an essential tool in the medical field, and that it is painted dramatically in doctor shows like House and Grey's Anatomy. It is rare that the medicine that you give someone thinking that they have one disease will react with the disease that they actually have and cause some sort of moral dilemma on the part of their doctors, friends and family. It always ends up that because they were given the wrong medicine they have to admit to some sort of huge infidelity or lifestyle secret. I feel like that sums up every TV episode: the undercover transgender person has to stop taking estrogen or else they'll get breast cancer or the wife of the man with the vasectomy has to admit that she got pregnant by sleeping with the mailman who has some one-in-a-million disease that causes his children to show have no blood type. Crazy stuff like that happens every day on TV. In real life, making sure that someone has a certain disease out of a list of others is part of a daily struggle to help cure people. It doesn't have to be any more complicated than that.

  10. "Differential diagnosis" is the means by which doctors can conclude what disease or illness a patient is suffering from. It involves observing the patient and taking note of any and all symptoms that the patient is exhibiting. Then, the doctors list a number of different diseases that the patient could possibly be afflicted with. Finally, they go down the list and, using the process of elimination, narrow down the possibilities until they have finally reached a conclusion on the patient's problem. Once they have figured out what they are up against, they can take the appropriate course of action in dealing with the disease.
    A benefit of this method is that is ensures that the doctor has a good reason for diagnosing a patient with a certain disease. If they simply go with their first instinct, there is a possibility that they will be wrong and the patient might suffer from their mistake. However, if a doctor instead lists all of the possible diseases that could be present in the patient's case, it is more likely that they will be able to help the patient get over their sickness. If their initial treatment does not seem to be working, then they have a number of other treatments to fall back on. Instead of simply coming to the realization that they were wrong and then having to find another course of action, the doctors can see an ineffective treatment as a positive thing because it means that they are one step closer to finding what the actual problem is.
    As a number of other people have mentioned, the negative side of this method is the amount of time that it can potentially take to determine what the patient's problem is. In less severe cases, this usually is not a problem because the patient can deal with their sickness for a while. However, if the patient is in critical condition, they may need a remedy quick and if the correct treatment is not given, they may die. Furthermore, it is also possible that ordering a treatment for the wrong problem could have adverse ramifications on the patient's health. For example, in the episode of House entitled "Three Stories", a patient is given an anti-venom for a snake bite but it turns out that the patient is allergic to the anti-venom which causes even more problems for the patient.

  11. Differential diagnosis describes the method that doctors use to find the illness that a patient is suffering from. The doctors will discuss the possible causes of the patient’s symptoms and come up with multiple diagnoses. There are many benefits to this method of diagnosing because as Brett has nicely pointed out, there are not two patients that are the same. This method forces doctors to keep all possibilities in mind and although some might be dismissed as Mitchell described, I think it would help more than it hurt. There might be cases in which the patient is hurt by the time spent trying to diagnose them, but is that better than being misdiagnosed? I really think that differential diagnosis has many more benefits than drawbacks and should be seen as a helpful method.