Early and correct diagnosis. Medical diagnosis of the patient and its types

DIAGNOSIS- DIAGNOSIS, DIAGNOSIS (from the Greek. diagnosis recognition). The word diagnostics means all those actions and reasonings, with the help of which the individual picture of the disease is reduced to the symptoms and characteristics of the organism known to the science of the given ... ... Big Medical Encyclopedia

diagnosis- to put an action to diagnose an action to put a correct diagnosis an action to put accurate diagnosis action to diagnose action ...

One of the most common diseases to diagnose. Karl Kraus We do not know what we live for; and doctors don't know what we're dying of, either. Henryk Jagodzinski Our illnesses are still the same as thousands of years ago, but doctors have found them more ... ... Consolidated encyclopedia of aphorisms

Make a diagnosis. Dictionary of Russian synonyms and expressions similar in meaning. under. ed. N. Abramova, M .: Russian dictionaries, 1999. diagnosis noun, number of synonyms: 3 conclusion ... Synonym dictionary

put- a question to put an action a matter to put an organization a diagnosis to put an action a task to put an existence / creation to put a matter an organization to put a question an action to put a voice change, a positive put a date ... Verbal compatibility of non-objective names

The definition of the disease, made by a doctor on one or another basis. A complete dictionary of foreign words that have come into use in the Russian language. Popov M., 1907. DIAGNOSIS recognition of a disease, determination of its quality by one or another sign. ... ... Dictionary of foreign words of the Russian language

DIAGNOSIS, a, husband. Medical report on the state of health, definition of illness, injury based on a special study. Put d. Clinical d. Preliminary, final d. | adj. diagnostic, oh, oh. Dictionary… … Explanatory dictionary of Ozhegov

- (inosk.) determine, draw up a conclusion (a hint of a diagnosis, a definition of a disease) Cf. Who has no hope? Now that I self-diagnose and treat myself at times, I hope that my ignorance is deceiving me, that I am wrong about ... ... Michelson's Big Explanatory Phraseological Dictionary

Make a diagnosis (inosk.) Determine, draw up a conclusion (a hint of a diagnosis, a definition of a disease). Wed Who has no hope? Now that I'm self-diagnosing and treating myself at times, I hope I'm being deceived by my... ... Michelson's Big Explanatory Phraseological Dictionary (original spelling)

BUT; m. [from Greek. diagnōsis recognizable] Determination of the nature and characteristics of the disease on the basis of a comprehensive study of the patient. Put d. D. was not confirmed. There is no diagnosis yet. ◁ Diagnostic (see). * * * diagnosis (from the Greek diágnōsis ... encyclopedic Dictionary

Books

• Analysis decoding. How to make a diagnosis on your own, Rodionov Anton Vladimirovich. The fourth book of the "Academy of Health" is devoted to the discussion modern methods laboratory diagnostics. Readers who like to explore or are forced to do so because of their…
• Deciphering the tests: How to make a diagnosis on your own, Rodionov A.V. Readers who love...

Doctors are meant to help people. Unfortunately, in difficult situations, they are not always able to save the patient, because the countdown is for seconds, and each decision may turn out to be fatal. Judging doctors because they are not able to heal everyone is wrong, because they are just people.

However, in some cases, the deplorable outcome could have been avoided if it were not for the negligence and inattention of the medical staff. Such behavior in without fail should be stopped, and the guilty should be punished. After all !

So, what to do if the doctor makes the wrong diagnosis?

Features of the crime

Cases in which medical errors, are considered one of the most difficult cases in legal practice. Patients are often dissatisfied with the work of doctors, but they do not always dare to start a trial, because evidence is needed to establish the wrongness of a medical employee.

So, it is necessary, first of all, to establish whether the diagnosis was made incorrectly through the fault of the doctor (due to his inattention or). For this purpose, a medical examination is carried out.

Specialists, using the results of the tests, recreate the situation in which the accused doctor found himself when making a diagnosis. If, on the basis of these data, the experts conclude that any doctor of appropriate qualification could make the correct diagnosis, there are grounds for calling the negligent doctor to responsibility.

Thus, setting is not correct diagnosis punishable when it was admitted through the fault of a doctor. It can be simple laziness, ignorance (there are often cases of professional illiteracy), inattention or bias towards the patient, in a word, an irresponsible attitude to one's duties.

For information about the danger of an incorrect diagnosis made by a doctor, see the following video:

Algorithm of patient actions in case of medical error

When a patient has reasons to suspect that he was diagnosed incorrectly (most often, this becomes clear from the deterioration of a person’s condition), this assumption should be confirmed or refuted.

Where to apply?

There are several instances to which you can apply in case of detection of an error by the attending physician.

It is most logical to start with the administration of the hospital itself, because if you immediately contact higher institutions, you will still be redirected there in order to clarify the circumstances on the spot.

The administration of the medical facility whose doctor made the wrong diagnosis

The first thing to do is to write a complaint to the head of the department in which you were treated incorrectly, or immediately to the name of the head physician if the situation is difficult.

Most of the time, problems are solved by this stage. The doctor's actions are considered by the management, and if they are found to be incorrect, your claims are satisfied.

If the hospital administration does not go to the meeting, responding with a refusal (in response to a complaint it must be made in writing), you should complain further.

Ministry of Health

The territorial office of the Ministry of Health can be found in each subject of the Russian Federation. At this body there is always a public reception, in which complaints from the population are accepted for consideration. After all, the purpose of this organization is to control the work of medical institutions.

There are several ways to file a complaint with the Ministry of Health:

• Personally;
• Send paper by mail;
• Send a letter of complaint by e-mail;
• Leave the text of the complaint on the official website.

As in the case of the hospital administration, they must answer you, and in the form that you indicated in the complaint. You have 30 days to consider your application.

Prosecutor's office

Since the duties of the prosecutor's office include monitoring compliance with the current legislation by citizens and organizations, filing a complaint against a doctor in this body is quite natural.

Court

To defend their rights, each person can file a lawsuit in court. However, it should be remembered that your claim must be substantiated and supported by evidence in the form sick leave, outpatient card, test results, and appointments.

It is with the help of the court that compensation for damage can be achieved when the management of the clinic refuses to solve the problem peacefully.

Material compensation in favor of the plaintiff will be requested from the organization in which the doctor who made the wrong diagnosis works. After that, the hospital can recover these funds from the negligent employee.

The claim is made in the usual way. All Required documents are attached to it.

Police Department

• In some cases, the negligence of doctors leads to significant consequences, described as grievous harm, the infliction of which through negligence is punishable under Article 118 of the Criminal Code of the Russian Federation.
• In addition, negligence (Article 293), non-compliance with accepted sanitary and epidemiological standards (Article 236) and concealment of certain circumstances that led to a deterioration in human health (Article 237) can become the reason for contacting the police.
• Very rare cases of deliberate application severe harm(111 article).

The fact that you are being treated incorrectly should also be reported to the insurance service, which will provide an examination.

If the mistake was made by the doctor private clinic, all of the above measures also apply. In addition, you can contact the department of Rospotrebnadzor, which monitors the work of all enterprises and legal entities.

Rules for filing a complaint

There is no fixed sample of a complaint against a doctor (including a pediatrician) about an incorrect diagnosis, so we will name only a few recommendations for compiling it, which will allow you to concisely and accurately state all the facts:

• Application header. It is written, as is customary, in the upper right corner of the sheet. It should contain the following information:
  • The name of the body to which this complaint is sent;
  • Full name and position of the person to whom the paper is addressed;
  • Personal data, including full name, phone number and address;
• In the center of the sheet under the heading, you must indicate the name of the document: "Complaint against the doctor" or "Claim";
• Main part. Here you need to briefly and succinctly state the situation, if possible, refer to the law that, in your opinion, has been violated. Here it is necessary to point out the available evidence;
• Registration of requirements (taking measures in connection with the negligent attitude towards the work of medical staff, calling to account, punishment, compensation for damage);
• Date and signature of the applicant;
• List of attached documents.

You can find the rules for filing a lawsuit in court in Article 131 of the Code of Civil Procedure of the Russian Federation. In principle, it will contain the same information. In addition, it will be necessary to indicate the fact that pre-trial measures have been taken, that is, an attempt to resolve the issue with the hospital administration before filing a lawsuit.

Finally, read about what threatens a doctor for an incorrect diagnosis in accordance with the articles of legislation.

Responsibility of the doctor and medical institution for incorrect diagnosis and treatment

To criminal liability for an error in appointments that led to grave consequences for the health of the patient, and doctors are rarely condemned for criminal negligence, and, as a rule, such a case receives a wide response.

Pain is probably the only symptom that every person has experienced at least once in their life. And we are not talking about ordinary bruises, but about the pain that is caused by the various pathologies. And in the first cleanest place is rightfully a headache that can turn a person's life into a nightmare. And if she is just a sign of another, hidden and from this even more dangerous disease, then its appearance cannot be ignored under any circumstances.

Causes of secondary headache

Unlike, which in itself is a disease and most often occurs in people who are long-term, secondary headaches appear against the background of other diseases. In the first case, you have to treat the headache itself, while in the second, doctors fight the underlying disease, devoting only part of their attention to headaches. The pathology will go away - the headache will also go away.

Here are the cases in which a symptom such as a headache occurs:

1. Head and neck injuries.
2. Vascular lesions of the spine cervical region) and skulls.
3. Defeats within cranial structures not associated with blood vessels:
   • brain tumors;
   • intracranial hypertension of various origins;
   • non-infectious;
   • epileptic seizure.
4. Toxic effects of various chemical substances or cancellation of such influence.
5. Infections, including intracranial.
6. Diseases in which the hormonal, acid-base, gas balance in the body is disturbed.
7. Pathologies of various structures of the skull, including the facial one.
8. Mental illness.

Head injury

One of the main symptoms of a concussion is a headache. Usually it is associated with the moment of trauma or occurs immediately after the person returns to consciousness. However, often, especially with moderate or severe concussion brain, a person’s head may not hurt at all.

Therefore, a doctor observing a patient who has injured his head must also identify other signs of a concussion:

• behavior change;
• impaired concentration;
• decreased ability to assimilate new information;
• memory impairment;
• impaired coordination of movements, etc.

Of course, the lion's share of these signs can be identified only with the help of people close to the victim. It is they who will be able to notice changes in behavior and other indicators that cannot be measured.

A concussion is far from the only complication of traumatic brain injury. As a result of a blow, a person can develop intracranial hematomas, foci of cerebral infarction (necrosis of brain tissue), and if there is a fracture of the bones of the skull, their fragments can also injure intracranial structures. That is why one interview of the victim and his relatives is not enough for accurate diagnosis. Doctors resort to instrumental and laboratory methods, such as:

• to detect fractures;
• magnetic resonance and, allowing you to see the smallest violations of the structure of the brain;
• Ultrasound, which visualizes a possible displacement of the brain as a result of a growing hematoma;
• lumbar puncture - with its help in cerebrospinal fluid detect an admixture of blood, which also indicates a hemorrhage between the membranes of the brain.

Treatment

Traumatic brain injuries are treated by neuropathologists or neurosurgeons. It often happens that after a few hours a person who looks practically healthy suddenly falls into a coma due to an undetectable intracranial hematoma. Any patient with a suspected concussion is admitted to the hospital for observation. Measures primarily consist in providing rest to the victim, prescribing analgesics to eliminate headaches, drugs that reduce intracranial pressure, if necessary - anticonvulsants and sedatives, drugs for dizziness.

In the presence of hemorrhages in the cranial cavity, its trepanation is performed. During this operation, the blood is removed and the wound is sutured. In the case of a hematoma, this is - the only way give the person a chance to survive.

Damage to the vessels of the neck and skull

The brain is one of the most demanding organs in terms of blood supply. It is no coincidence that cardiac arrest leads to its death in just 5 minutes, while skin cells, for example, can live for more than 6 hours after complete cessation nutrition.

Damage to the arteries that feed the brain inevitably affects its blood supply, and this is primarily manifested by unilateral or bilateral constant headaches, often not responding to the use of sufficiently strong painkillers.

Treatment

Inflammatory lesions of the CNS vessels are usually treated with precisely measured doses. hormonal drugs and cytostatics. In case of vascular dissection, an operation is performed to introduce a vascular prosthesis at the site of damage to the vessel. Without treatment, a person suffering from such diseases is doomed.

Intracranial hypertension (ICH)

This syndrome can develop due to many diseases:

• brain injuries;
• tumors;
• endocrine diseases;
• intracranial infections.

The reason for it is a deterioration in the outflow of cerebrospinal fluid from the cranial cavity during its normal production or an increase in its synthesis with an adequate outflow. This is due to the appearance of obstructions on the outflow path in the form of scars (after trauma), tumors, hypervitaminosis A, brain development anomalies, etc. Headache at the same time, it is constant, in intensity it varies from mild to unbearable, vomiting(usually in the morning), occurs mainly at night and in the morning. In parallel with this, there is a drop in working capacity, nervousness, instability. blood pressure, a feeling of failure in the work of the heart, sweating and other vegetative signs.

Suffering people become weather-sensitive, their health deteriorates, predicting a change in the weather.

Treatment

First of all, of course, it is necessary to treat the condition that led to ICH: infection, tumor, concussion, etc. However, in some cases, this syndrome itself has to be dealt with. For this, diuretics are used, which increase the absorption of cerebrospinal fluid into the blood and its excretion.

In mild cases, sometimes limited non-drug methods- right drinking regimen, manual therapy, massage, physiotherapy. In cases of severe ICH, it may be necessary to install a bypass for the outflow of cerebrospinal fluid into the canal spinal cord if the main path is insurmountable.

brain tumors

With brain tumors, headache is highly variable. Often it resembles a tension headache, but it can differ both in localization and in intensity. This symptom occurs in 17% of cases of all oncological pathology of the brain, regardless of whether the primary tumor is located in it or whether it is a metastasis of cancer of another organ.

Squeezing by volume formation brain structures leads to the development intracranial hypertension, hydrocephalus, in which the headache is distributed throughout the head and is most severe in the morning. It subsides after a few hours, unlike a tension headache.

When squeezed nerve centers there is also a symptomatology corresponding to the lesion of one or another nerve - paresis, local or generalized paralysis.

Treatment

Like any oncopathology, brain tumors are treated with radiation, radio and chemotherapy. In some cases, microsurgical operations are used to remove the mass formation. Elimination of the tumor or its reduction in size often leads to the disappearance of headaches.

Substance intoxications and their withdrawal

Many substances contribute to the appearance of a headache when in contact with them. Poisoning carbon monoxide, arsenic, alcohol, drugs, histamine, etc., can cause a diffuse headache, sometimes not even relieved by strong analgesics. Some medications may also have side effect in the form of a headache.

There is an overuse headache that occurs due to the abuse of painkillers. In this case, there is a kind of paradox - taking analgesics instead of reducing headaches contributes to their intensification after a short period of relative well-being.

Finally, sometimes the headache is caused by the withdrawal of the substance being taken. There is a well-known "withdrawal" when trying to stop drinking coffee. Headaches are persistent, moderate, and usually disappear without a trace a few weeks after caffeine withdrawal.

Treatment

In case of poisoning toxic substances, drugs, alcohol, detoxification measures are carried out. With drug abuse, treatment is carried out by discontinuing the drug that caused the disease. With withdrawal headaches, a change in approach to the withdrawal of the corresponding substance should be made. It is necessary to “jump off” it gradually, gradually reducing the dose. Thus, the body adapts to the changed circumstances and has time to develop internal painkillers.

intracranial infections

And encephalitis - these two scary words known to many. The headache in some forms of these diseases is so monstrous that even adults turn into crazed creatures writhing from it. In young children, it causes a continuous monotonous cry. The nature of the pain is bursting, pressing, it usually covers the entire head.

Treatment

Depending on the microbe that caused the disease, antibiotics are used, antiviral agents, drugs that improve cerebral circulation and cerebrospinal fluid drainage, pain medications, and glucocorticoids.

Infections of the cranial structures

, - here is the most common cause headaches with damage to the structures of the skull.

Ethmoiditis - inflammation of these paranasal sinuses the nose is accompanied by a moderate constant exhausting headache, which only partly responds to taking analgesics. This pain is associated with irritation inflammatory process cranial nerves that transmit impulses to the pain centers of the brain.

Treatment

At chronic inflammation structures of the facial skull, antibiotics, anti-inflammatory and painkillers are used. With sinusitis, the doctor can perform a puncture of the corresponding sinus and even a full-fledged operation. Pain subside as the inflammation in the corresponding organ disappears.

Headache is one of the most common clinical signs many diseases. Even simple classification various headaches takes up 9 pages of small text. Obviously, it is extremely difficult to identify the cause of this symptom on your own. A simple intake of pills “from the head” is just a “crutch” that does not heal, but temporarily postpones an acute phenomenon. And you need to treat not a symptom, which is a headache, but a disease that provoked its appearance. And here better than a doctor no one can do it.

YOUR CORRECT DIAGNOSIS

The most important in medical business is to identify the cause that destroys human health. The doctor, together with the patient, needs to establish, identify, find the "criminal". If it is clear which disease causes suffering, then there is clarity in the treatment. Once the diagnosis is made, it is easier to proceed further. But making the correct diagnosis is not only the most important thing in clinical medicine, but also the most difficult. Despite the achievements of modern medicine, the emergence of expensive diagnostic complexes despite all efforts medical workers Unfortunately, it often happens that we fail to convict the "criminal". When there is no exact, correct diagnosis, the doctor has to act blindly, and the treatment prescribed in such situations is often ineffective.

A person sometimes gets sick so hard that sometimes even a pathologist in a section after lethal outcome, having the opportunity to look into any corner of the body, cannot say what a person was sick with. Sometimes the pathologist, who is the last resort, cannot establish the correct final diagnosis. The cause of death in such situations is established as the most probable.

An experienced clinician differs from a less experienced one in that the less experienced one gets the most job satisfaction when he cures the patient. More experienced doctor he also rejoices at the recovery of the big one, but he experiences the greatest satisfaction when he makes the correct diagnosis in a difficult patient, when he catches the "criminal" and "puts him behind bars."

The vast majority of patients are convinced that making the correct diagnosis is the business of doctors only. They are sure that absolutely nothing depends on them here. it typical mistake, an embarrassing misconception.

If the doctor and the patient work together on the diagnosis, then the diagnosis is more accurate, more correct.

What can a patient without medical education, to make sure that the diagnosis was made correctly?

First of all, he must include himself in the team of medical professionals who care for him. He must become a full-fledged, full-fledged partner, a member of the team, he must play an active role in the diagnostic and treatment process, and not be a passive observer. The quality of information depends on the patient, the accuracy of the data on the basis of which the doctor makes a diagnosis. How correctly the patient will be able to broadcast to the doctor what is happening in his body, so correct will be his diagnosis. If these data are crooked, so will the diagnosis. It has already been noted that uncertainty is part of medicine. The patient can reduce this uncertainty.

In the previous chapters, I have already dwelled in detail on what and how the patient should give the doctor so that the doctor makes a complete, correct diagnosis. Here I deliberately used the verb "give", realizing that the phrase can be interpreted in two ways. Provide accurate, objective, full information about your illness and about yourself. No one knows your body better than you, the features of its reactions. Only you know what matters most to you. As noted, the doctor cannot feel the disease for you. The doctor only helps to convey the manifestations of the disease to the patient. Being clear about what is happening to you is very important. Sometimes this is not easy for the patient. Most often, patients give either too little information or overload their speech with details that are absolutely irrelevant.

It is necessary for the patient to strive for clarity of presentation, since the correctness of the diagnosis depends on it.

After the doctor, having analyzed the data obtained, informed you of your diagnosis, ask on the basis of what, on what data, he came to such a conclusion. Let him convince you that you are suffering from exactly the disease that he speaks of. In the vast majority of cases, this can be done with two or three simple sentences. If the doctor speaks firmly and in words that you understand, the “criminal” is caught. If you see doubts, hesitations, dissatisfaction, sometimes verbosity of a conscientious, competent, experienced doctor, then diagnostic search may need to continue. Here, without even delving into the meaning of what has been said, but by the way the doctor answers your question about the reliability of your diagnosis, one can judge with big share probability of its validity.

Peace of mind is what a smart patient should look to their doctor for when they ask to be convinced of the correctness of their diagnosis.

If you are a "difficult case" and are given the most likely diagnosis, do not hesitate to ask your doctor what other conditions may be causing these symptoms. This will help the doctor to take a broader look at the problem, to “spread the net” more widely, to extra work on differential diagnosis, be more creative. Let his thought process, his "torment" in making a diagnosis be in front of you. This will allow you to join the search process. Ask your doctor what else can be done to clarify the diagnosis. What should be your next steps to catch the "criminal".

An important and well-established technique for difficult diagnoses is the second opinion. If you are exposed to the most likely (approximate) diagnosis and there is no complete clarity of what exactly is happening to you, it is advisable to consult another doctor. This does not mean that the first doctor is bad. Clinical medicine is full of uncertainties. Different doctors have different experiences, different schools, they think differently. It may well be that the second doctor already had a patient with similar problems that he managed to solve. The second doctor may be more "corrosive" or more interested in this branch of medicine. AT difficult situations both the third and the fourth opinion are not excluded. According to American doctors, the second opinion changes the treatment and diagnostic tactics in 1/3 of cases! A good clinician will never be offended if you tell him about your desire to consult another doctor.

With particularly difficult diagnoses, it is advisable to consult narrow specialists with extensive experience. As a rule, in such cases, the patient should contact large medical research centers that specialize in certain areas of medicine. It is best for the patient to look for such centers together with his attending physician. Sometimes the problem can be solved only in our capitals, and sometimes - only abroad.

Watch your body's reactions. Be proactive if your prescribed treatment is not working or you are getting worse. Let your doctor know about this. There must be a strong relationship between you and your doctor Feedback . In such a situation, do not strive to go through the entire prescribed course of treatment, to bring it to the end. The reason for this may be that you are being treated for another illness. It happens. Find out with your doctor why the treatment is not working. Perhaps it is too early to wait for improvement, and the deterioration is due to the work of the drug. Or perhaps your diagnosis is wrong and you should continue the diagnostic search.

In our country, there are few organizations that really protect the rights of the patient, and there are no structures that help patients to be included in the diagnostic and treatment process. In this regard, our patients should be much more active than, say, in developed countries where such structures exist. For now, it's the other way around.

Medical workers in Western countries better prepared, more motivated, better equipped, but their patients, who seemed to be able to relax, are much more active than ours. Therefore, in the West they live longer.

Understanding that much depends on the patient in identifying the disease gives him the opportunity to live longer.

Your right diet malignant neoplasms. It must be taken into account that the manifestations of each of them are different. In this regard, one cannot speak of general diet for all cancer patients, consideration should be given to