Content area
Full Text
WHAT DO WE MEAN BY DIAGNOSIS?
Diagnosis is defined as "the identification of the nature of an illness or other problem by examination of the symptoms". 1 Its origin is from the Greek words "dia" meaning "apart" and "gnosis" meaning "knowledge". There are, in fact, three distinct terms for "knowledge" in Ancient Greek. "Skene" is the kind of knowledge derived from observation and is the origin of the English word "science". "Mathein" is the kind of knowledge derived from calculation as with "mathematics". "Gnosis", meanwhile, is a deeper inherent knowledge. It yields, for example, the English word "recognise".
Through diagnosis we provide patients with labels to identify illness or disease. We infer an understanding of the anatomical and pathophysiological mechanisms behind their disease process. It is only through diagnosis that we are able to prescribe treatments and develop management plans for our patients. Without applying at least some form of diagnosis, the practice of medicine would not be possible.
TRADITIONAL CONCEPTS OF DIAGNOSIS
Our traditional concept of diagnosis derives from a philosophical approach or paradigm known as "positivism". Positivists believe that we can find out "how things really are" or "how things really work". 2 Reality exists, and it is driven by immutable natural laws. It is possible for us to appreciate that reality by adopting a neutral and distant position and making objective observations about it. We develop hypotheses and subject them to verification. By observing constant relationships between variables, we can derive "laws" and "rules" that we can confidently state as "facts".
Incorporation of the word "gnosis" into "diagnosis" is entirely consistent with the positivistic framework. Thus, physicians can recognise illness and be sure of its nature. Indeed, positivism would hold that, having objectively researched a particular investigation and proven its diagnostic use, we may implement it and know whether our patient has the disease under investigation. As such, we know whether a patient is anaemic by his or her haemoglobin concentration or whether an injured patient has a fractured bone from the radiograph. Ultimately, a positivist viewpoint holds that a patient either has or does not have a particular illness. It is possible to investigate this objectively and to categorically present our diagnosis as a fact.
Under scrutiny the positivistic paradigm becomes...