Tuesday, November 20, 2012

The Existential Diagnosis


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When I was in practice in Denver, a Family Physician won a court case by insisting that his diagnosis was his alone, and that the diagnosis did not exist until he made it. --- Lawyers like this kind of thinking. --- The doctor claimed that the same pattern of symptoms and complaints could be called many things, but as the patient’s physician, only he and the patient were privy to those complaints and, therefore, whatever diagnosis the doc assigned to that condition was intrinsically correct. It was his diagnosis. He owned it, and it was his means of classifying this complex of clinical findings.
Interestingly, a similar assignment of diagnosis takes place in the clinical pathological conference, (CPC). The summary will refer to the clinicians’ diagnosis, the surgeon’s diagnosis, the Radiologist’s diagnosis or the pathologist’s diagnosis. Such is the ambiguity of the clinical findings in difficult cases. In the later, the pathologist’s autopsy findings generally win out.

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