Makes a diagnosis in other words. How to help the doctor make the correct diagnosis? . General concepts of diagnosis

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 modern medicine, the appearance 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. The more experienced doctor also rejoices in the recovery of the big one, but he experiences the greatest satisfaction when he puts correct diagnosis in a difficult patient, when he catches a "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 who does not have a medical education do to ensure that the diagnosis is correct?

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 made up 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.

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Our body often gives us certain signals about a disease. Absolutely any disease has a number of some signs, which are called. In order to correctly diagnose, you need to identify them. This process is called diagnosis.

General concepts of diagnosis

What does the concept of “diagnosis” mean in medicine? This is nothing but the recognition of an ailment. Moreover, this is not only the disease itself, but also the results of the patient's study, which allow the specialist to move from thinking to treatment.

When staging, the specialist is guided by the complaints of the applicant (symptoms), examination of the patient and the results of the tests. This takes into account gender, age, place of residence and other non-medical factors.

It is customary to distinguish several types of diagnoses in medicine: clinical, pathological-anatomical, forensic, epidemiological.

How to diagnose by symptoms?

Previously, only people who had a special medical education, but after the Internet entered our lives, many of us began to engage in diagnostics and prescribe medications ourselves. This is not good, because without being a professional in this matter, you can easily make a mistake in making a diagnosis, and because of this, there can be serious consequences.

First of all, you need to carefully monitor. Its rapid decline can signal many ailments, for example, hyperthyroidism (excessive secretion of hormones thyroid gland). This disease women are often exposed young age. As for the elderly, sudden loss weight may indicate malignancy.

If you get sick, then watch how long the cough lasts. If this continues for more than 3 weeks, it may indicate a serious illness. For example, bronchial asthma, about tuberculosis, pneumonia or other oncological diseases.

How to make a tongue diagnosis?

AT normal condition our tongue should be pink, have a slight cover and be weak, which can be removed with a toothbrush. If it begins to thicken over time, acquire a yellowish or gray shade, this indicates a reduced immunity.

By the way, if you find a white-yellow coating in the morning and it can be easily removed with a brush, then this is not a reason to panic. And if this could not be done, then this may indicate a fungal infection, various diseases oral cavity or dysbacteriosis.

Pale plaque may indicate anemia, while another sign can also be distinguished: fatigue.
If you have appeared gray coating, then this may indicate that your body does not have enough iron.
When it is slightly enlarged and has a pale coating, and when low acidity, on the contrary, is slightly reduced and drier.
A yellowish color may indicate liver pathologies.

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 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, making an incorrect diagnosis is punishable when it was made through the fault of the 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.

In ancient times, when there were no methods and hardware diagnostics, doctors, in order to determine the patient's condition, relied only on external signs of trouble. After carefully looking at the person for some time, the doctor confidently diagnosed him.

Today, the conclusion about the disease, as a rule, is made only after the patient has undergone necessary analyzes. But at the same time experienced doctors, just like their ancient predecessors, widely use diagnostics based on external signs. Actually, why shouldn't the patients themselves adopt some of the observations of doctors? After all, this will help a person quickly navigate his condition and not rack his brains over which specialist he should sign up for, but an appointment, and in the office, immediately clearly identify his symptoms. This will greatly help the doctor in your treatment.

Here is a list of some signs of disease, proposed by American doctors.

Legs. Feet hurt a lot of people, and in old age they bother almost everyone. After all, they carry a huge load every day. Noting in which places this load manifests itself most of all, you can understand what changes are taking place in your body.

So, if a hard corn "horseshoe" stretches along the edges of the heels, especially with cracks, this indicates possible problems with joints or the musculoskeletal system in general. For example, if the skin hardens along the outer edges of both heels, then you need to pay attention to the condition of the spine, if inside, closer to the instep of the foot, it is worth checking the intestines. Rough skin on inner edges thumbs legs should prompt you to visit an endocrinologist and ask him to examine your thyroid gland.

Looking at swollen calves and ankles, usually talk about an excess of water in the body and, accordingly, about shortcomings in the functioning of the kidneys and heart. But the reason for this can be the most banal - swelling often occurs if a person sits at a desk for a long time or, conversely, stands for many hours on his feet (as, for example, hairdressers). In such cases, it is easy to get rid of edema, and at the same time an extra static load on musculoskeletal system, changing the position of the body every half hour and doing a little warm-up. It is also useful to redistribute the load of the foot: for example, walk on tiptoe, on the outer and inner edges of the foot, massage the sole. The fact is that there are dozens of biological points connected with all internal organs kneading which will activate these organs. If your condition allows of cardio-vascular system, give your legs a feasible load: walk more, climb top floor not on the elevator, but on their own.

Leather. This one big organ human body can tell a lot about him. In particular, dry and flaky skin indicates a lack of vitamins, A or B, white spots on the skin may indicate a lack of a number of other vitamins, including C. They are also a sign of thyroid disease or developing diabetes.

It happens that "bruises" remain on the body from the slightest pressure. In this case, it is necessary to consult a specialist in blood diseases, because the appearance of hematomas is a symptom of anemia and a number of other diseases of the circulatory system.

Nose. When red streaks appear on the tip of the nose, it is usually thought that the person is prone to alcohol. But to the same extent it indicates problems with the heart muscle. If the entire tip of the nose turns red, one can think of a decrease in the function of the stomach and duodenum. The white tip of the nose indicates problems with blood circulation.

Nails reddish brown color indicates kidney disease. thick neck often accompanied by the appearance of goiter - a disease of the thyroid gland associated with a deficiency in the body of iodine.

Much capable tell your eyes, which is not accidentally called the mirror of the soul and body. Diagnosis of the iris of the eye has long been included in the arsenal of doctors. But you can not even know about the nuances reflected through the iridology device, but judge the state of health by appearance eye. If they are clean, clear, with a clear pattern of the iris, then everything is fine in the body. Redness, "blurring" of the iris may indicate problems with the liver. But the swelling of the lower and upper eyelids can indicate both a violation of the heart, kidneys, and problems with gynecology.

If you have bad hearing, this may indicate many problems, not counting directly "ear". Hearing loss often occurs with hypertension, osteochondrosis cervical, diseases of the kidneys, brain and a number of other ailments.

If the doctor did not make the correct diagnosis, then this does not always indicate his lack of professionalism, sometimes the diagnosis depends on the patient. How can you help your doctor make a diagnosis?

A typical visit to the doctor most often looks like this: the patient describes his symptoms, takes tests and undergoes examinations, then the doctor analyzes the information and makes a diagnosis. The clinical picture is not always clear, so the diagnosis is a theory based on symptoms. Often there are circumstances that prevent a correct diagnosis.

There are three types of misdiagnosis:

Misdiagnosis - the doctor compared the symptoms with the wrong disease and made a mistaken diagnosis;
Delayed diagnosis - the diagnosis was made, but the doctor did not prescribe treatment until the symptoms became more unambiguous;
Missed diagnosis - the disease fits the symptoms, but the doctor did not make a diagnosis.

Many medical errors occur due to the fault of the patient, for example, people often suppress certain facts, considering them insignificant. In order for the doctor to make the right decision, you must help him. Treat this information with all your attention, as a wrong diagnosis makes you waste money and effort, and also undermines your trust in doctors.

Doctors make a wrong diagnosis in about 10% of cases, and it does not matter the status of the doctor and the level of the medical institution.

High achievements in the field medical technologies play an important but not decisive role. Conclusions of the most modern tomographs and results genetic tests will be interpreted by a person who may be mistaken. It's about about the simplest and most common diagnoses, rare diseases, on the contrary, are most often diagnosed accurately.

First of all, you need to understand that a doctor is a person just like you, he can also get tired, get distracted by serious problems at work or family, being hungry or not getting enough sleep. Nobody is immune from medical error, you don’t need to react to them too emotionally, your task is to follow a few rules and help the doctor make a diagnosis.

Find an experienced and caring doctor

Physicians must be meticulous with their patients and patient in gathering information. If you have a thought that your doctor is neglecting additional examinations, then you need to find another specialist whom you will trust.

Get ready for your visit

Before visiting a doctor, write down all your complaints on a piece of paper, as well as serious changes in your life lately, these can be strong psycho-emotional upheavals, traveling abroad, physical exercise and other. Consider every factor that could somehow affect your condition. During the initial visit to the doctor, you need to prepare for him all the results of the latest tests and examinations, the conclusions of other specialists, as well as a list of all the diseases that you had before.

Talk about all the symptoms

Just state to the doctor everything that you feel, without missing a single symptom, perhaps an insignificant trifle will help the doctor build a logical chain. When you describe pain, mention the nature of the pain when it first appeared. Speak clearly and voluminously so that the doctor does not have to extract information from you or think it out on his own.

Ask about all diagnostic options

Very often doctors choose the most severe symptoms and select a diagnosis for them, so do not hesitate to ask a question, what other disease can be with the same symptoms? A simple question will allow you to get more information about your health, and will give the doctor the opportunity to look at your clinical picture on the other hand.

Check information about surveys

If the doctor has prescribed tests and examinations for you, then ask him about each of them, you need to understand why you should take this or that test, in parallel with this, the doctor will justify the diagnosis for you.

Don't think that the absence of bad tests is good news.

If all examinations and analyzes show normal values, then you should not be glad that you are not sick with anything. If you continue to feel unwell, tell your doctor about it, pay attention to every sign of the disease.

Respect the doctor's work

You should never get into a conflict with a doctor or react to him too emotionally, this will only prevent him from making a correct diagnosis. At the doctor's appointment, be calm and reasonable, do not spread negative emotions to a specialist, they will immediately reflect on you.

Understand your role in making a diagnosis

A correct diagnosis can be made only with the joint coordinated work of the doctor and the patient. If you feel like you're getting little attention, consider looking elsewhere.