Making the Diagnosis

The diagnosis is made by careful evaluation of the database, analysis of the information, assessment of risk factors, and development of the list of possibilities (the differential diagnosis). The process includes knowing which pieces of information are meaningful and which can be thrown out. Experience and knowledge help to guide the physician to "key in" on the most important possibilities. A good clinician knows how to ask the same question in several different ways and to use different terminology. For example, patients at times may deny having been treated for "pelvic inflammatory disease" but will answer affirmatively to being hospitalized for "a tubal infection." Reaching a diagnosis may be achieved by systematically reading aboul each possible cause and disease. The patient's presentation is then matched up against each of these possibilities, and each is either placed high up on the list as a potential etiology or moved lower down because of disease prevalence, the patient's presentation, or other clues. A patient's risk factors may influence the probability of a diagnosis.

Usually, a long list of possible diagnoses can be pared down to the two to three most likely ones, based on selective laboratory or imaging tests. For example, a woman who complains of lower abdominal pain AND has a history of a prior sexually transmitted disease may have salpingitis; another patient who has abdominal pain, amenorrhea, AND a history of prior tubal surgery may have an ectopic pregnancy. Yet another woman with a 1 -day history of periumbilical pain localizing to the right lower quadrant may have acute appendicitis.

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