I’ve always taken great pleasure in making a diagnosis. But for me, I go back to the roots of the word. A diagnosis is an understanding. It thrills and delights me to be able to understand people. I think that’s the beginning of the journey to health, because as I concentrate on trying to understand someone, they usually increase their understanding of their condition and even of themselves. That’s powerful and I think, as we are all meaning seeking creatures, it’s a key goal of most consultations – to make sense of our lives (through the creation of our stories) But I reject the reduction of diagnosis to labelling or categorising. For me, that’s just not good enough. I want to know more than the name of a disease. I want to know a person.
Iona Heath writes eloquently about diagnosis in this week’s BMJ
Beyond the technical expertise of those in the craft specialties, the key skill of all doctors is diagnosis. However, diagnosis itself poses profound problems of scope and usefulness. Every experienced clinician is fully aware that no two people ever experience the same diagnosed disease in exactly the same way, and yet the taxonomies of diagnosis and the international classifications that underpin them ignore this underlying truth. The diagnoses tabulated in this way are theoretical abstractions, but we are inclined to give them a level of credence and reality that tends to exceed that granted to the patients so labelled. In this way, our diagnoses begin to condone structural violence and to excuse social injustice
Good diagnosis is an individualising process, not a generalising one.