CLINICAL DIAGNOSIS

Clinical Diagnosis

(The Present Article is a humble attempt to illuminate the interpersonal relationship between the doctor & the patient)

Medicine is an inexact science, we are accustomed to this concept, in its various dimensions & coloration… The articulate doctor would say that he will apply all his professional expertise for the therapeutic relief and management of his patients follow the universal protocols and practices but, nevertheless, the outcome and results may still be eventful! The nature of the anatomical anomalies, physiological changes, aggravated pathology, terminal or palliative stage of the disease and curable or treatable form of its manifestation may, ultimately bring in to picture the real time patient care, or lack of it.   

The first and foremost tool at command of physician is the pair of hands and the pair of eyes which the Mother Nature has best stowed upon him. The undergraduate course in its curriculum carries the sharpening of visible perception of the subject (patient) … the physical appearance, the tell-tale signs and presentations escalated  by the symptomatic jugglery of the disease process, and is magnified into a provisional or conformed positioning or likelihood of the issues, which the patient is suffering from, in other words known as ‘diagnosis’. The course of treatment may start with the accurate diagnosis of the patient, the timely ‘diagnosis’ of the patient and the skillful picking up of other alerts like the co-morbid conditions.  (mis-diagnosis, error in diagnosis and sometimes missed diagnosis derails a course of treatment without any intentional lapse on the part of the care giver)

It’s not out of context to state that the trajectory of alleged medical negligence  steeply goes down where the per capita time spent by the clinician with  the patient is comparatively more, during which there is a random exchange of complaints, conditions, difficulties and problem areas vocally and expressly shared by the patient himself and the rapt attention paid by the clinician to hear and listen, see and watch, capture and observe, pickup and apply and make up a firm mind to give the best treatment of choice.

Few Self tests for ensuring knowledge sharing & accuracy in diagnosis In general clinical settings:

1   Protocol - There is no rule of thumb or any judicial prerogative that can be used as a bench mark for preventive measures that may be observed by all the doctors during their first encounter with the patients. The academic, practical, on job training and experience hours determine the acumen of the intuitive clinical skills.

    Watch-the-watch – It is immaterial whether by the watch a physician makes up his mind to spend few minutes to an hour or more to understand the problems of his patient. But more than the quantity aspect it is the qualitative filter that comes into play, the former leading to the latter and not otherwise.

 Communication Skills – Other than the formal training of physical examination of the patients, the language should never become the barrier between the patients and their doctor. It is all the more important that the simplest form of language, even vernacular may be used for communication between the two. The person in pain can explain better the points of its generation or referral, whereas the physician is trained to use  the touch and pressure to determine the nature and extent of the same in order to reach the most immediate and probable cause behind the same.

Why ‘co-relate’ clinically – in the world  of radio diagnosis, laboratory analysis and other digital examinations of the human anatomy  required collectively or in isolated branches or vital organs, the courts have consistently held that the examiner shall highlight the observations on objective basis by laying out the parameters and the acceptable  standards. However, with the basic qualification as a pathologist or a radiologist or a laboratory technician, the professional shall not give his mind on the diagnosis unless the referring consultant has requested or directed for a specific probe or the professional holds a higher qualification to state so. However, in both the conditions the opinion of the primary consultant shall prevail.

Technology at its best or worst – in recent times the Honorable High Court of Uttrakhand issued directions that medical professional shall not impose or subject their patients to unnecessary tests and laboratory examinations unless actually required. This judicial view fortifies the strength of the clinical diagnosis and the sanctity of the reasoned opinion of the physician after clinical examination of the patient. It also rests at bay the apprehensions in the minds of the cautious and preventive practitioners who are into passive medication after the advent of high compensation awards given by courts in malpractice litigation.

“All the clinical establishments throughout the State of Uttrakhand are directed that the patients are not unnecessarily put to diagnostic tests. Only necessary diagnostics tests are ordered to be undertaken to access the clinical condition of the patient. The State Government is directed to prescribe the rates for various diagnostic tests or procedures or surgeries or treatments extended by clinical establishments …” (Ref : WPPIL – 120/16  AHMAD NABI VS STATE OF UTTRAKHAND, Dated 14^th Aug 2018)