Quoting Eram:
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FROM THE DP:2The Diagnostic Process
This chapter provides an overview of diagnosis in health care, including the committee's conceptual model of the diagnostic process and a review of clinical reasoning. Diagnosis has important implications for patient care, research, and policy. Diagnosis has been described as both a process and a classification scheme, or a “pre-existing set of categories agreed upon by the medical profession to designate a specific condition” (Jutel, 2009).1 When a diagnosis is accurate and made in a timely manner, a patient has the best opportunity for a positive health outcome because clinical decision making will be tailored to a correct understanding of the patient's health problem (Holmboe and Durning, 2014). In addition, public policy decisions are often influenced by diagnostic information, such as setting payment policies, resource allocation decisions, and research priorities (Jutel, 2009; Rosenberg, 2002; WHO, 2012).
The chapter describes important considerations in the diagnostic process, such as the roles of diagnostic uncertainty and time. It also highlights the mounting complexity of health care, due to the ever-increasing options for diagnostic testing2 and treatment, the rapidly rising levels of biomedical and clinical evidence to inform clinical practice, and the frequent comorbidities among patients due to the aging of the population (IOM, 2008, 2013b). The rising complexity of health care and the sheer volume of advances, coupled with clinician time constraints and cognitive limitations, have outstripped human capacity to apply this new knowledge. To help manage this complexity, the chapter concludes with a discussion of the role of clinical practice guidelines in informing decision making in the diagnostic process.
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OVERVIEW OF THE DIAGNOSTIC PROCESS
To help frame and organize its work, the committee developed a conceptual model to illustrate the diagnostic process (see Figure 2-1). The committee concluded that the diagnostic process is a complex, patient-centered, collaborative activity that involves information gathering and clinical reasoning with the goal of determining a patient's health problem. This process occurs over time, within the context of a larger health care work system that influences the diagnostic process (see Box 2-1). The committee's depiction of the diagnostic process draws on an adaptation of a decision-making model that describes the cyclical process of information gathering, information integration and interpretation, and forming a working diagnosis (Parasuraman et al., 2000; Sarter, 2014).
