The American Chiropractor Volume 36, Issue 6

PERSPECTIVE Are You Missing Out on the Most Powerful Tool in Making a Diagnosis? By Wayne L. Sodano, DC, DABCI, DACBN, CFMP, ND rriving at a medical diagnosis requires infonnation obtained from a patient history, physical examination, and the results of laboratory investigation. "In 1947, Platt claimed that in most cases, a diagnosis can be made with the patient history alone."1 In 1975, Hampton and coworkers attempted to evaluate the relative contributions of the patient history, physical examination, and laboratory tests when making medical diagnoses in their study of 80 referral patients at a general medicine clinic. They found that the diagnosis predicted after taking the history agreed with the accepted diagnosis h'Vo months after the initial visit for 66 of the 80 patients (82%), while the physical examination led to the diagnosis for seven patients (9%), and the laboratory investigation led to the diagnosis of the other seven patients (9%). 2 "In 1975, Winkler conducted a prospective study of 100 inpatients on historytaking diagnosis. The result of his study concluded that the history-taking diagnosis was the same as the final discharge letter in 72% of the cases."3 In 2000, Rosh and Rao conducted of blood chemistry software programs designed to interpret a similar prospective study of 100 patients. "In 77 patients lab results and make treatment recommendations should not (78.58%), the history led to the diagnosis. " ~ serve to feed this trend. For example, consider lab results that disclose low levels of the thyroid honnones T4 and T3. Most "The physical examination is the process of evaluating objec- blood chemistry sofh'Vare programs do not account for envitive anatomic findings through the use of observation, palpa- ronmental toxin exposure, microscopic internal bleeding, or tion, percussion, and auscultation. The infonnation obtained preexisting autoimmune disease-all of which can contribute must be thoughtfully integrated with the patient's history and to low thyroid honnone levels. pathophysiology. The single most useful device for optimal perfonnance of the physical examination is an inquisitive mind and sensitive mind. Nel\.1 most useful is mastery of the techniques of observation, palpation, percussion, and auscultation. Less important are the tools required for the exam. The physical examination, thoughtfully perfonned, should yield 20% of the data necessary for patient diagnosis and management. If the history and physical examination are linked properly by the clinician's reasoning capabilities, laboratory tests should in large measure be confinnatory." 5 A The most important tests we have ever devised for obtaining clinical diagnoses are history-taking and physical examination. What does all of this data tell us? It tells us that the most important tests we have ever devised for obtaining clinical diagnoses are history-taking and physical examination. In conclusion, the most powerful tool that clinicians have is their contact with patients during the clinical evaluation. ConWe have a large number of invasive and noninvasive labo- structing a good history improves your diagnostic capability, ratory tests at our disposal. Many of these tests are el\.1remely enhances the doctor-patient relationship, and thereby improves expensive, and in my opinion, may be ordered uIDlecessarily patient compliance and optimizing treatment outcomes.6 if a thorough comprehensive patient history is obtained. It is Acknowledgement(s): Ron Grisanti, DC, DABCO, MS , a growing trend that time-constrained clinicians have begun leaning toward the reliance of laboratory tests for a final diag- DABCN, CFMP; Sequoia Education Systems, Inc.lFunctional nosis. Although they may be a helpful tool, the recent influx Medicine University, www.FunctionalMedicineUniversity.com 44 I The American Chiropractor I JUNE 2014 www.theamericanchiropractor.com

The American Chiropractor Volume 36, Issue 6 | Page 48