Diagnosis is numero uno in the field of medicine. It begins with anamnesis (history taking) followed by physical examination of the patients, along with some diagnostic procedures. When a patient (human or animal) is presented to the hospital with any sort of medical affection, the doctors are believed to diagnose the case first without putting a patient directly on some medicaments. In human or animal medicine diagnosis is one of the most gruelling task due to nonspecific signs and symptoms of a disease. Redness of the skin (erythema) is one of the exemplar by itself as it is a sign of many disorders and thus doesn’t enlighten the clinician what is wrong. Medical diagnosis is a cognitive process where a diagnostician uses numerous sources of facts, figures and puts the pieces of puzzle together to make a diagnostic impression. After the initial diagnostic impression the clinician obtains follow up tests and procedures to set more data to support or reject the original diagnosis and will attempt to taper it down to a more specific level. There are diverse subtypes of diagnosis which includes clinical diagnosis, lab diagnosis, radiology diagnosis, principal diagnosis, admitting diagnosis, differential diagnosis, diagnostic criteria, prenatal diagnosis, diagnosis of exclusion, dual diagnosis, self diagnosis, remote diagnosis, computer aided diagnosis, over diagnosis, waste basket diagnosis etc.
Doctors are being encompassed with such branches of diagnosis, but do they implement these diagnostic methodologies in their routine practice? As far as our Kashmir valley is concerned the human and animal healthcare sector is currently in shambles. It’s just a game of profit and loss. The clinicians nowadays just prescribe a laundry list of drugs to their patients without any confirmatory diagnosis. Because of these unethical practices doctors who are practicing sincerely become the victim too. From my personal experience I have seen clinicians jotting down list of meds blindly just to treat the symptoms of the disease and satisfy their patients for short-term without diagnosing the root cause. Such types of malpractices both in human and animal medicine are the prime cause of drug resistance these days chiefly antibiotic resistance. This type of practice creates an erroneous notion in people that the best doctor is one who by his medicaments brings instant ease. So we the people of medical fraternities must not forget a rightly said famous quote by Benjamin Franklin “The best doctor gives the least medicines”. Every drug has its own consequences and if prescribed unnecessarily and in excessive doses it leads to adverse effects. Adverse drug effects are a widespread problem and can lead to significant injury and even death in the elderly. Physicians, nurses, & pharmacists are all accountable for the medication regimen. The statistics regarding adverse drug effects are shocking that revealed 30 % more money being spent in the U.S.A on treating adverse drug effects than on all pharmaceuticals combined and 50 % of older adults receiving prescriptions from more than one prescribing clinician. The following questions you must ask the nursing home staff or medical provider if you suspect medications are unnecessary or causing adverse effects.
- Is this medication compulsory?
- Is the drug contraindicated in the elderly residents?
- Is the resident taking the least effective dose of the drug?
- Are meds being used to treat side effects of other medications?
- Can the drug regimen be simplified?
- What is the potential drug interactions of the medications currently prescribed?
So diagnostic testing plays a paramount role in early detection and identification of specific disease pathogens and other aetiologies so that targeted treatments can be instilled. As a veterinary clinical pathologist and clinical practitioner, diagnostic medicine has always been the big part of the plan. Sometimes the problem may be easy to identify grossly, as is the case with skin abrasions, complete fractures of long bones, and missing body parts (e.g., cropped tails, removed digits, puncture wounds, etc.), cataracts and nuclear sclerosis in older pets. However, sometimes we need the aid of diagnostic tools to better pinpoint where the main problem is. That way focused medicine and client education can be implemented. In other cases where diagnostics are not used, empirical treatment may suffice. However, running the diagnostic tests first may allow us to find out sooner the exact issue so that focused therapy can quickly get the problem resolved. The use of the many diagnostic tools to assure we are treating the patient with the necessary medications to curb their illness is just one part of being a competent veterinarian or human doctor as well. Haematology and clinical chemistry analyzers, the use of the light microscope to evaluate faecal and urinalysis samples and the development of various “SNAP TESTS” to determine if an animal is ailing with common or sometime uncommon diseases is a must. Often individuals may become so familiar with certain disease presentations in patients that the diagnostics may be foregone. In human medicine, the patient is able to communicate vital information to the practitioner to aid in determining what treatments should be implemented. However, in veterinary medicine the client may give us this vital information, but still the diagnostic testing is of the utmost importance to really get to the root of the problem. Habitually large animal practitioners may not perform blood work and so some of the great cases that our large animals ail with are treated empirically. One may recognize when there is a displaced abomasum, “downer cow” or goat with bloat. Whatever the illness, be encouraged to find the definitive diagnosis, which is often decided after performing few or many diagnostic tests. Go that extra step and educate the client on the reasons why diagnostic testing is necessary. When a patient with an infection, whether internal or external, is treated empirically with an antibiotic and the wound does not heal, it decreases the ability of culture to find the culprit. Now we have the development of Methicillin Resistant Staphylococcus aureus (MRSA) and flesh-eating bacteria. Culture and sensitivity should be performed first and then antibiotics may be put into practice until the results of this vital diagnostic tool are received. That way, the antibiotic may be changed if there is an indication on the sensitivity results. Instead of finding out the hard way that the antibiotic is not working and then trying to culture the lesion, it’s better to run diagnostics first. Complete blood counts, serum biochemical profiles, urinalysis and faecal examinations are the minimum databases that must be encouraged by all to use more frequently. Therefore, a clinician must rely on diagnostic medicine instead of symptomatic treatment of the case. Doctors must not forget that a misdiagnosis may award an individual the right to file a medical malpractice suit. There are number of reasons that would warrant a medical malpractice suit for a misdiagnosis like a negligent action taken by a doctor, a failure to adhere to the code of conduct necessary for all doctors to abide by, or a blatant wrong doing that stems from laziness or the doctors inability to deliver a routine medical action. Patients undergoing unnecessary surgery or chemotherapy will inevitably result in a negative effect in the form of unwarranted scars, sickness, and the loss of wages. These instances are grounds for medical malpractice suits.
“Better a murder than a Misdiagnosis”
Dr. Abrar Ul Haq Wani is a research scholar in Department of Veterinary Medicine SKAUST K
