And accurate diagnosis depends on :

1.Careful history.

2.Thorough examination.

3.Judicious use of lab.

" Diagnosis" actually means ‘Understanding through knowledge’. It does not mean wild guessing but guessing by considering 'n' number of conditions possible (this is to some extent based on past experience also) and carefully ruling out one by one. Thus we can say that it is systematic guessing.

The solution of patient problems is, in certain regards, deceptively simple. All that is required is accurate and selective information about the patient (a database), an understanding of the characteristics of disease and illness (an information base), and a method of comparing the first to the second that yields a diagnosis, and the corresponding treatment.

Forming hypotheses early in the diagnostic process helps

Develop a personal epidemiology of clinical experience, focussing on problems that are common, treatable, and/or serious.

It consists of three principle steps :

1.History taking.

2,Examination.

3.Investigation (if necessary).

All the steps are not necessarily independent. One step may preceed or follow another or two may occur simultaneously.

  History taking (Eliciting Symptoms)

History taking is in fact ‘Probing’ .It is the Linchpin of the diagnostic procedure.

The hint is to go serially and follow a fixed pattern .Listening patiently to your client itself can be healing in some cases like Psychosomatic disorders.

(After analysing more than 200 problems-ridden doctor-patient relations , one investigator found that by advising docs to ask their pts. "What would you like me to do for you ?" at the beginning of every visit , they improve both parties' satisfaction)

It is essential that the physician have a firmly established habit pattern of history taking. This includes the family history, the history of past illnesses, the review of systems, and personal and social matters.

The advantage of a role pattern are :

1.No intellectual effort is devoted to what topic is next, and full attention can be devoted to interpreting the meaning of each response, and

2.It is much less likely that a topic will be overlooked. Thus no effort and no missing out !

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1.Preliminaries : Name-Age-Sex-Address (NASA) Occupation, Status (social/marital) Ht.Wt. This should also include socio-economic conditions when we are concerned with Public Health  Diagnosis (Community Diagnosis).

3.Past history :Of medical (illness,drug,allergy)orsurgical (operations,accidents,trauma).

4.Personal and family history :Habits, hygiene, diet and about sibs, parents.

    Thus history taking can be divided conveniently into five simple steps :

                i. History of  symptoms .

                ii. History of  associated features.

                iii. History of  likely etiologies.

                iv. History of complications.

                v. History of treatment taken.

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  AT THIS POINT THERE MUST BE A SET OF TENTATIVE DIAGNOSES IN MIND .IT IS BETTER TO HAVE ONE DIAGNOSIS IN MIND BEFORE EXAMINATION. THIS HELPS IN BRANCHING- OUT FROM THE ROUTINE DURING THE EXAMINATION PROCEDURE. IT ALSO HELPS IN SELECTING AND DELETING FROM A CLUSTER OF DIAGNOSES.

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