Diagnoses Without Names: Challenges for Medical Care, Research, and Policy

ISBN-13: 9783031049347 / Angielski / Miękka / 2022

Lockshin, Michael D.

Opis

Doctors, patients, investigators, administrators, and policymakers who assign diagnoses assume three elements: the name describes an entity with conceptual or evidentiary boundaries, the person setting the name has a high degree of certainty, and the name has a consensus definition. This book challenges this practice and offers an alternative to assigning diagnoses: quantitating diagnostic uncertainty in personal and public medical plans.

This book offers the stakeholders' views participating in a workshop, sponsored by the Barbara Volcker Center/Hospital for Special Surgery, taking place in April 2020, about uncertain diagnoses. Chapters examine the circumstances in which diagnosis names are "unassignable", either because patients do not fit within diagnostic "boxes" or because health abnormalities evolve and change over time. In addition, the book deconstructs the processes of diagnosis and explores how different stakeholders used diagnosis names for various purposes. In examining pertinent questions, the book offers a roadmap to achieving consensus definitions or including measures of uncertainty in personal care, research, and policy.

Diagnoses Without Names: Challenges for Medical Care, Research, and Policy is an essential resource for physicians and related professionals, residents, fellows, and graduate students in internal medicine, rheumatology, and clinical immunology as well as investigators, administrators, policymakers.

Spis treści

Preface

PART I. DEFINING DIAGNOSTIC UNCERTAINTY

 

1. Diagnosis: An Illustration of Uncertainty: SLE/Lupus Spectrum 

2. Diagnosis: Syndrome, Genome, or Both?

3. What Level of Detail Defines Uncertainty in Diagnosis?

4. Frequency of Diagnostic Uncertainty: All Doctors, or Tertiary Care Specialty Clinics Only?

5. Frequency: Rheumatologists or All Chronic Illness Specialties? 

PART II. DECONSTRUCTING THE CONCEPT OF ‘DIAGNOSIS’ 

6. Patients’ Entry into the Medical World (Strengths and Weaknesses of History, Examination, Laboratory)

7. Other Data Sources (Severity, Time, Sociological, Environmental, Cultural Factors)

8. Deconstructing the Thought Process by Which Diagnoses are Made (Subjective and Objective Data; Quantitative and Qualitative Data; The Effect of Time) 

9. Quantitating Uncertainty

10. Methodological Pluralism (Syndrome, Genome, Externalities, and Other Factors; Diagnoses Change as Science Evolves) 

PART III. THE PUBLIC PURPOSES OF “DIAGNOSIS”

11. Physicians, Patients

12. Clinical Scientists, Basic Scientists

13. Pharma

14. Payers, Policy Makers, Public

15. Fiscal Effects of Uncertain Diagnoses

16. Is Diagnostic Certainty Required?

PART IV. CONCLUSIONS AND RECOMMENDATIONS

17. Conclusions

O autorze

Michael D. Lockshin, MD, MACR

Director, Barbara Volcker Center

Hospital for Special Surgery

Professor of Medicine and Obstetrics Gynecology

Weill Cornell Medicine

New York, NY

Mary K. Crow, MD

Physician-in-Chief

Chair, Department of Medicine

Benjamin M. Rosen Chair in Immunology and Inflammation Research

Hospital for Special Surgery

Chief, Division of Rheumatology

Joseph P. Routh Professor of Rheumatic Diseases in Medicine

Weill Cornell Medicine

New York, NY

Medha Barbhaiya, MD, MPH

Assistant Attending Physician

Barbara Volcker Center for Women and Rheumatic Disease

Hospital for Special Surgery

Assistant Professor of Medicine

Weill Cornell Medicine

New York, NY