Instinctively I'm sure your basic notion that diagnosis is a function
of the choice of management (rather than the classical notion that it
is diagnosis first)is correct much of the time. John Howie's work
suggesting that (in something as clearly defined as sore throat) the
context influenced the treatment-diagnosis is the only stuff I can
recall off the top of my head. The back pages of this month's BJGP have
an article by John referring to this and also one by John Bain
outlining two research studies based on empirical treatment-diagnosis
which never obtained ethics approval because specialists "knew" that
proper doctors don't work like that.
I'm not so sure about your "this might be a case of prozac, now I'll
try and prove it" hypothesis. I *think* my way is to operate a high
index of suspicion for depression and to follow up any soft cues with
one or two fairly specific questions ( eg concentration, sleep,
enjoying food) and then work in form there if I think there's something
in it, but whether I would do this if I didn't think it was worth
diagnosing depression (and even not-depression)I'm not sure. And any
way that's only my way.
Chris
Dr Chris Burton
Sanquhar Health Centre
Dumfriesshire DG4 6BT
(01659) 50221
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