# "Assessment" versus "Diagnosis": what are the differences?



## mycrofft (Feb 9, 2010)

I know the classic divisions: techs can assess and consult, MD's and RN's* can diagnose and treat. Techs and nurses' medical treatment (other than basic safety and comfort measures and items outside medicine like mechanical extrication) stems from protocols or standardized procedures written and/or approved by MD's which specify objective findings leading to specific measures, and the qualification to attain before you can do these measures.

In the real world, *do you personally feel the use of the word "diagnose" is bad *in reference to the acts of evaluation then treatment without getting a case by case real time order from higher medical authority by EMT's of any level?

*"Nusing diagnosis" is a recognized term, has been organized and formalized, and is in use.


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## firecoins (Feb 9, 2010)

Its called a differential diagnosis. Using a limited assessment, littles knowledge and little ability to do a whole lot, we make a working guess on whats going on.  You can it a differential diagnosis which will need to be confirmed by the MDs at the receiving facility.

A real diagnosis can not be made by EMTs.  Not enough info or education.


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## Veneficus (Feb 9, 2010)

I don’t like the wording on the poll.

Diagnosis is using physical and history findings combined with knowledge of anatomy, physiology, pathology, and other basic sciences too numerous to list to come up with a likely "name" (aka explanation) about what is going on with a patient so one can formulate the best plan of treatment.

Some EMS providers diagnose, some just treat signs and symptoms following a cookbook. I am more fond of the former than the latter, but sadly I concede it is possible to be an EMT or Paramedic and never make a diagnosis in a career. Likewise one could diagnose every patient they ever see irrespective of title.

The more information you have, the more accurate a diagnosis can be. Certainly as a patient progresses through the levels of care more information can be gathered that help to better diagnose.

Some treatments can be effective for large time periods covering various pathologies. Some treatments have a very narrow range of time and pathologies they are effective in. Some treatments are needed to give the most accurate diagnosis. Diagnosis and treatment therefore are seemlessly connected. A truly proper treatment would require some level of diagnosis. As we know, there are many EMS providers (as well as other healthcare providers) who perform improper treatments trying to equate signs and symptoms alone. A good example is edema, there are many causes of pulmonary edema. Not all resulting from congestive heart failure. Not all respond well to loop diuretics. Sometimes the wrong treatment is harmful at some level, sometimes it does nothing, and sometimes can be effective to some level.  

There are lots of qualifiers for diagnosing. “Initial diagnosis,” “working diagnosis,” “differential diagnosis,” They are simply various levels of the same behavior. 

The cultures of some agencies are to be mindless laborers; in some agencies the culture is to be a critical thinking professional.  About the only things both have in common is they call themselves the same title and they don’t like each other and vehemently defend their way as the one true faith.


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## mycrofft (Feb 9, 2010)

*I hear you Ven.*

You too firecoins.

It is interesting to see the way agency protocols etc. can get twisted up versus state and county regulations, versus real world (good or bad real world).
In my experience "cookbooking" is the solid floor, and making a "working diagnosis", eval, assessment, wildarsed guess or epiphany based on solid education and experience is a bridge to selection and use of the proper protocol.

E.G.: three EMS walk up to a pt dispatched as "coughing up blood".

Nancy wants to urgently start a large bore IV, O2, C spine, and is considering MAST.

Betty spends twenty minutes doing a by the book workup with family hx and postural VS's including temp.

Annie takes VS, looks the pt over on approach and during VS, talks to him ab out whats happening/meds/etc. and looks down his throat, detects a mild retronasal bleed, finds out this is recurrent, and tells pt to go see MD if it doesn't stop in an hour. Total time: ten minutes from approach to code 4, 10-8, 10-19.

Who's right?


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## LondonMedic (Feb 9, 2010)

firecoins said:


> You can it a differential diagnosis which will need to be confirmed by the MDs at the receiving facility.


Or pathologists. ^_^

I would suggest that in the absence of a definitive investigation result everyone goes on a differential, be they doctor, paramedic or first responder. As often as not that means doing an assessment, to a level of detail appropriate to the settingm forming a differential diagnosis appropriate to the setting and initiating 'best guess' treatment appropriate to the setting.


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## LondonMedic (Feb 9, 2010)

mycrofft said:


> E.G.: three EMS walk up to a pt dispatched as "coughing up blood".
> 
> Nancy wants to urgently start a large bore IV, O2, C spine, and is considering MAST.
> 
> ...


None is wrong (I presume that's your point).

Annie is the obvious 'right' answer here, but her course of action here are entirely inappropriate if she doesn't have the experience, knowledge and authority (not to mention insurance) to act in that way. That also presumes that she has the ability to be certain that she has the time to do that.


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## Veneficus (Feb 9, 2010)

Since all of the examples are correct treatment, I guess the question becomes who is providing the best treatment?


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## Lifeguards For Life (Feb 9, 2010)

Attached is an excerpt from an article written by David W. Powers, NREMT-P, BCETS, BCECR, last year.

While I do not agree with the underlying principle behind the article, he does bring up some valid points on paramedics diagnosing.



> Physician assistants are healthcare professionals licensed to practice medicine with physician supervisionPAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive healthcare, assist in surgery, and in virtually all states can write prescriptions. This definition comes from the Information About PAs and the PA Profession section at www.aapa.org. As I outline the comparisons, I think youll see that as far as two careers in the healthcare field go, we arent that different.
> 
> Paramedics are also healthcare professionals licensed or certified to practice medicine with physician supervision. I know some people say we dont practice medicine, but we do. We practice medicine under our medical control physicians license. We conduct physical exams, except we call them patient assessments.
> 
> ...


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## JPINFV (Feb 9, 2010)

mycrofft said:


> Nancy wants to urgently start a large bore IV, O2, C spine, and is considering MAST.
> 
> Betty spends twenty minutes doing a by the book workup with family hx and postural VS's including temp.
> 
> ...



Nancy is wrong. There's no indication yet for any of those interventions. They all *may* be appropriate depending on the exam findings, but just because the patient is coughing up blood doesn't mean that it's a life threatening emergency. We just don't know yet.

Betty represents the ideal course of action under the current education standards and EMS treatment theory, provided there isn't any critical exam findings like hypotension. 

Annie represents the ideal course of action, but may be inappropriate (especially the treat and release) for the vast majority of paramedics in the US given the current education standards.


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## VentMedic (Feb 9, 2010)

Lifeguards For Life said:


> Attached is an excerpt from an article written by David W. Powers, NREMT-P, BCETS, BCECR, last year.
> 
> While I do not agree with the underlying principle behind the article, he does bring up some valid points on paramedics diagnosing.


 
That article has described just about every health care professional from PT to RN when it comes to assessment and "prescribing" as the author is attempting to make his own interpretation. Giving medications from a protocol is not prescribing. A Paramedic does not write the order or protocol to give the medicine. The doctor has already written that for the Paramedic in the protocols. A Paramedic can not get a DEA number and does not need one any more than an RN or RRT. 

Pulse oximetry is also not a definitive diagnostic tool used to make a definitive medical diagnosis. 

Both PAs and NPs are true physician extenders and can make a "medical diagnosis" which a Paramedic can not. Paramedics and many other licensed professionals make a working diagnosis for treating certain signs and symptoms by protocols. 

http://www.wapa.org/pdfs/np-pa_chart.pdf



> While certainly regular-duty paramedics don’t assist in surgery, interns in paramedic school are frequently *allowed to view surgeries*. Some paramedics actually perform surgical procedures as part of their job. Surgical cricothyroidotomies, chest tubes, central catheters, postmortem cesarean sections and field amputations are only some of the surgical skills that *many paramedics* in the United States are authorized to perform.


 
I would emphasize the word "some" used at the beginning of that paragraph. Also, being allowed to "view a brain surgery" does not make one a neurosurgeon. 



> Although there are many variables that go into the reasoning behind the salary gap, I see two as having the most impact: education level and place of employment


 
He seriously missed on this one. PAs are certified providers for CMS or Medicaid and Medicare and generally receive favorable reimbursement from commercial payers. And of course the fact they do diagnose, can order many invasive tests and prescribe treatment as well as medication could be part of the salary difference. Until a Paramedic is recognized as a Physician Extender, the differences are many as is the education.


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## mycrofft (Feb 9, 2010)

*OK forget the three girls for a minute, they were just thought-fodder.*


What exactly, without legal def's, _is_ a diagnosis?

Personally, I'm not hung up on the terminology as long as I know who did what and their qualifications. After the podiatrist put the young lady with a broken nose and neck pain into the back seat of a Mustang and we had to board her out, I'll take info from anyone whno knows what the heck they are about.


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## Lifeguards For Life (Feb 10, 2010)

mycrofft said:


> What exactly, without legal def's, _is_ a diagnosis?
> 
> Personally, I'm not hung up on the terminology as long as I know who did what and their qualifications. After the podiatrist put the young lady with a broken nose and neck pain into the back seat of a Mustang and we had to board her out, I'll take info from anyone whno knows what the heck they are about.



The process of  considering the patient’s signs and symptoms, medical background and laboratory findings, to identify an underlying cause.

If you take your vehicle to a mechanic, does he diagnose mechanical problems? Does a veterinarian diagnose your pet?

Why are we taught the Cincinnati prehospital stroke scale, hunt and hess scale, the Los Angeles prehospital stroke screen, if not to aid in a rapid diagnosis of a stroke?

Is that 'diagnosis' likely to change? yes. though i am sure all of you perform the appropriate stroke screening test when warranted and transport to the appropriate facility. If you are taking a stroke patient to a stroke center, have you not 'diagnosed' a stroke?


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## MrBrown (Feb 10, 2010)

Ambo's make a provisional diagnosis; no more and almost certianly less depending upon the specific ambo


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## Veneficus (Feb 10, 2010)

Lifeguards For Life said:


> The process of  considering the patient’s signs and symptoms, medical background and laboratory findings, to identify an underlying cause.



I don't think labs are required to make every Dx.


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## JPINFV (Feb 10, 2010)

Of course, because EMS can't run the highest valued medical test possible...

[youtube]http://www.youtube.com/watch?v=2BDd0XseGtU[/youtube]


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## Lifeguards For Life (Feb 10, 2010)

Veneficus said:


> I don't think labs are required to make every Dx.



No, not by any means. But, if those values were available and the provider was capable of interpreting them, they may aid in a quick and accurate diagnosis. I also know full well that they will never be available in the prehospital setting.


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## MrBrown (Feb 10, 2010)

Lifeguards For Life said:


> No, not by any means. But, if those values were available and the provider was capable of interpreting them, they may aid in a quick and accurate diagnosis. I also know full well that they will never be available in the prehospital setting.



Sssssh, don't tell Novia Scotia or Alberta who are doing field cardiac enzymes


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## VentMedic (Feb 10, 2010)

Lifeguards For Life said:


> If you take your vehicle to a mechanic, does he diagnose mechanical problems? Does a veterinarian diagnose your pet?


 
I hope you are not comparing a car to the complex systems of the human body.

I also expect my veterinarian to run whatever tests necessary to  provide proper treatment for my pet.



Lifeguards For Life said:


> Why are we taught the Cincinnati prehospital stroke scale, hunt and hess scale, the Los Angeles prehospital stroke screen, if not to aid in a *rapid diagnosis of a stroke?*
> 
> Is that 'diagnosis' likely to change? yes. though i am sure all of you perform the appropriate stroke screening test when warranted and transport to the appropriate facility. If you are taking a stroke patient to a stroke center, have you not 'diagnosed' a stroke?


 
The use of a scale is great to identify the possibility of a stroke to initiate some care that can be very broad for many neuro problems and not just a stroke.   Hopefully it does get the patient to the appropriate center but that scale is merely the very beginning of a long process and sometimes it may not be a "stroke" at all.    However, for a Stroke Center to be a Primary, it must be able to do diagnostic testing 24/7.  It must also have the ability to place the patient in an appropriate unit setting even if that means sending the patient to another facility.   Of course the best facility would be one that is a full service neuro center just like the best hospital for an MI would be one that can also do cardiac surgery and not just a cath lab procedure. 

Stroke Center Criteria...if you are interested.
http://www.strokeassociation.org/do..._Program_Capacity_Assessment_Tool_05.2006.doc

The chest pain protocol can also be an example.  It may look like an MI but there are many, many other causes that can also present with the same symptoms.  Generally the initial treatment of "MI" symptoms are broad enough where they can be applied with some benefit and may not do more harm.   We could also use CHF vs PNA.  These two are difficult since they can actually both be present.    There are also many patients that even the physicians will be working from their preliminary diagnoses (yes more than one) for many days or weeks until a definitive one is made.  Some patients will generally have more than one problem as well.  Without the availability of some diagnostics, it is difficult to just go by "what you see is what you got".   It would really be great if all the medical problems a patient could possibly have are just the few learned in EMT or 
Paramedic. 



Veneficus said:


> I don't think labs are required to make every Dx.


 But the Paramedic's training and education does not provide enough knowledge to know if more testing is needed.  If you make the obvious dx of an arm fx on a young person, would the Paramedic be able to recognize other signs and symptoms to where there might be a more serious cause for a brittle bone?   If you give morphine and the pain goes away, does that mean you have fixed the MI?  If you apply CPAP to a "CHF" patient and they breathe better, have you fixed the CHF? If you give albuterol to an asthmatic patient and they breathe better, have you fixed them and no more treatment or testing is required?  Too often some Paramedics, I hope not that many,  are led to believe if the symptoms go away with the treatments they provide in the prehospital setting, they have fixed the patient and are providing the same level of care as a physician.  However, the knowledge base of the Physician will be much more extensive to know when and when not to do more testing or that alleviating a "symptom" does not fix the problem.  The Paramedic also has no ability to keep that symptom from reoccurring by prescribing ongoing treatment.  That is also another difference between a PA and a Paramedic. 

I know it sounds like I am down on Paramedics but one should realize their limitations from the education they have gotten in a Paramedic program.  If not, something can also be missed when a Paramedic attempts to place all patients within just their few "working diagnoses".  It is also okay to say you don't know which protocol to initiate for some things which is why you have access to med control for advice.


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## Veneficus (Feb 10, 2010)

VentMedic said:


> But the Paramedic's training and education does not provide enough knowledge to know if more testing is needed.  If you make the obvious dx of an arm fx on a young person, would the Paramedic be able to recognize other signs and symptoms to where there might be a more serious cause for a brittle bone?.



I do not think a paramedic has enough education to know if/when further testing is required, I was stipulating that not all Dx require lab work. Some do, others don't. 




VentMedic said:


> If you give morphine and the pain goes away, does that mean you have fixed the MI?  If you apply CPAP to a "CHF" patient and they breathe better, have you fixed the CHF? If you give albuterol to an asthmatic patient and they breathe better, have you fixed them and no more treatment or testing is required?  Too often some Paramedics, I hope not that many,  are led to believe if the symptoms go away with the treatments they provide in the prehospital setting, they have fixed the patient and are providing the same level of care as a physician.  However, the knowledge base of the Physician will be much more extensive to know when and when not to do more testing or that alleviating a "symptom" does not fix the problem.  The Paramedic also has no ability to keep that symptom from reoccurring by prescribing ongoing treatment.  That is also another difference between a PA and a Paramedic.



These are treatments to conditions, I do not see what this has to do with Dx. unless you are using the treatment to imply the Dx which in most cases is not the accepted practice for any provider.


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## VentMedic (Feb 10, 2010)

Veneficus said:


> These are treatments to conditions, I do not see what this has to do with Dx. unless you are using the treatment to imply the Dx which in most cases is not the accepted practice for any provider.


 
Actually they are treatments for the symptoms of the disease process.  The CHF patient may need more diagnostics to determine the cause. The asthmatic may need steroids and/or antibiotics to treat the exacerbation.  The "MI" patient will need more diagnostics to determine if it is an MI or something with very similar symptoms.  Of course, since only half of ALS EMS services have 12-Lead ECG capability, that leaves out one valuable tool.  Then there are a few services which do have the 12-Lead that rely solely on machine interpretation for the diagnosis.


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## Veneficus (Feb 10, 2010)

Might as well lock this thread up too.


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## LondonMedic (Feb 10, 2010)

MrBrown said:


> Sssssh, don't tell Novia Scotia or Alberta who are doing field cardiac enzymes


Are they holding the pt in the back of the ambo for twelve hours?! 

I know travel times can be long, but seriously...


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## VentMedic (Feb 10, 2010)

LondonMedic said:


> Are they holding the pt in the back of the ambo for twelve hours?!
> 
> I know travel times can be long, but seriously...


 
Why would you hold a patient for 12 hours?

POC testing can generally give a troponin (protein) level in about 15 minutes.  It can at least be used to determine destination if travel distance is great or used to initiate treatment based on clinical assessment and a 12-Lead ECG.


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## LondonMedic (Feb 10, 2010)

VentMedic said:


> Why would you hold a patient for 12 hours?
> 
> POC testing can generally give a troponin (protein) level in about 15 minutes.  It can at least be used to determine destination if travel distance is great or used to initiate treatment based on clinical assessment and a 12-Lead ECG.


I know, I use these machines regularly, they are both a blessing and the bane of my life.

The key question questions here; what is the significance of an immediate troponin?

Do you not do serial (6hr and 12hr) trops? Immediate trops are usually -ve and often misleading. Even +ve trops are often misinterpreted.


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## VentMedic (Feb 10, 2010)

LondonMedic said:


> I know, I use these machines regularly, they are both a blessing and the bane of my life.
> 
> The key question questions here; what is the significance of an immediate troponin?
> 
> Do you not do serial (6hr and 12hr) trops? Immediate trops are usually -ve and often misleading. Even +ve trops are often misinterpreted.


 
Let me repeat my post:



VentMedic said:


> POC testing can generally give a troponin (protein) level in about 15 minutes. It can at least be used to determine destination if travel distance is great or used to initiate treatment based on clinical assessment and a 12-Lead ECG.


 
If we have a positive tropinin on a symptomatic patient, we may still transport to a facility that has a cath lab regardless of the ECG since an ECG can be nonspecific. Waiting 24 hours for ECG changes might cost heart muscle. Remember, no one should ever rely on just one test and clinical correlation is a necessity.

While one would more than likely transport to a cath lab center, that may not always be the case depending on local protocols. As well, if you have a LONG transport time, there is a good chance the cath lab team members may have a long drive time when activated if not in house 24/7.

But, these machines are not on all EMS trucks and are generally reserved for a few Flight, CCT and Specialty transport teams.


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## mycrofft (Feb 10, 2010)

*"Diagnosis" versus "assessment" boils back to transport time versus benefit?*

It seems to me then , by looking at the poll, that we can provisionally agree that for all intents and purposes field EMS does "diagnose" ,  if not by that name. Then the depth and quality is affected by practice limits/protocols and practicality (time factor from scene to hospital).


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## dave3189 (Feb 11, 2010)

*Dictionary defintion*

*Diagnose: to determine the identity of (a disease, illness, etc.) by a medical examination.  to ascertain the cause or nature of (a disorder, malfunction, problem, etc.) from the symptoms*

I can't believe we are still having this age old discussion?  I always find that the nay sayers of this debate are often the medics that are worried about protecting their "turf".  Bottom line, to diagnose something does not mean it is a complicated procedure that requires an advanced and/or invasive protocol? 

As an EMT-B, how can it be logically or rationally deemed "not a diagnosis" when I arrive at a scene and see an 8 year old child in respiratory distress, with a peanut butter cookie sitting next to her with Mom saying she is allergic to peanuts.  BP shows her hypotensive, she has red/rashy skin.  Hmmm, my medical assessment along with a history points to Anaphylaxis treated with Sub Q Epi and an ALS response.  Remind me again how that isn't a diagnosis???  

How about a more simple example... I arrive at a call of a teenager who wiped out on his skateboard.  Upon assessment I see an open Tib fracture.  Protocol is for me to control bleeding, dress & splint and transport with 02 while monitoring vitals.  Again, while a very simple call... I diagnosed this patient with an open fracture.  What is so difficult to comprehend about this topic?


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## JPINFV (Feb 11, 2010)

dave3189 said:


> How about a more simple example... I arrive at a call of a teenager who wiped out on his skateboard.  Upon assessment I see an open Tib fracture.  Protocol is for me to control bleeding, dress & splint and transport with 02 while monitoring vitals.  Again, while a very simple call... I diagnosed this patient with an open fracture.  What is so difficult to comprehend about this topic?



Nope... sorry... that's just a painful swollen deformity.


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## dave3189 (Feb 11, 2010)

My bad, I should have requested a Medic Unit to "diagnose" my "observation".


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## VentMedic (Feb 11, 2010)

So a sign and a symptom is essentially a diagnosis?

How many causes of CHF? Is it a sign, symptom or a disease or all? Can you make the diagnosis of acute renal failure as the cause or diagnosis? 

What about wheezing? COPD or Asthma? What about all the other causes or disease processes? Do you treat the signs and symptoms or do you immediately go straight with asthma? What if it is an aspirated object? Does that change the diagnosis of the wheezing? 

How much is "assumption"? Look in the scenarios heading for examples of the "guessing game" where some assume but really don't have much data to go on.

What about the commonly made diagnosis of "hyperventilation"? Isn't it really a symptom called tachypnea since there is not clinical data to prove hyperventilation? 

What if you do a glucose check on a trauma patient and find a higher BGL? Are you going to assume the patient is a diabetic? 



> Protocol is for me to control bleeding, dress & splint and transport with 02 while monitoring vitals.


 
For the fx, if you have diagnosed it, why O2? Aren't you just following your protocols instead of actually clinical findings of hypoxia? Are you also going to stop your assessment since it is so "obvious"? Any chance of emboli? 

And, for the respiratory distress, are you going to stop your assessment after giving the SQ? Since the child was eating, is aspiration and obstruction also not a possibility as well? Rarely are things always as easy as they seem and to ASSUME one thing you may miss another. 

Yes, you must work under a preliminary diagnosis to initiate your protocols but one should also not stop assessing or believe that one diagnosis is the end all to every problem. 

Let's do another scenario since pericarditis was just mentioned in anther thread. How about the "typical" OD patient with a history of IVDA. The narcan barely touches him. Do you suspect endocardititis which can lead to a CVA and/or MI? Or do you stick with the obvious of OD and keep giving narcan to the limit allowed by your protocol? Can an unconscious patient tell you about chest pain or slurred speech? So no, not everything will be a simple textbook diagnosis and treatment symptoms or signs as you find them will be all you can do. Just assuming you made "a diagnosis" and running with that may not provide all the treatment that can be done. 

If you have ever shadowed the ED physician, you will find they may list as many as 6 or more differential diagnoses even with something that seems really obvious and will continue to treat the signs and symptoms as they appear until some definitive data is available.

This is to get some to thing there is more than just the obvious and rarely will a patient have just one diagnosis but can have many signs and symptoms that can pertain to many disease processes each with a different definitive treatment but similar treatment of the signs and symptoms.


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## dave3189 (Feb 11, 2010)

Where does it indicate that a "diagnosis" has to reach some specific, (and yet unmeasurable) level of advanced diagnostic/clinical medicine to be considered such?  

According to your contention, an attending at the ED who treats an elderly woman from a fall who scans her and finds a hip fracture isn't diagnosing her?  How does he know that she doesn't have osteoporosis?  According to your theory, the Doc is just treating the symptoms of the disease?  What you fail to realize is there is always another layer of diagnostic speciality that a patient can be referred to.  

I had a laminectomy when I was a kid for a herniated disc.  It was caused by a staff infection that reached the lumbar area of my back.  I guess the orthopedist who examined me, interpreted the films and performed the surgery didn't diagnose me? I suppose he was really only treating the back symptoms which were secondary to the infection.  I was examined and treated by a pathologist who treated the infection, so he must have been the one to have ultimately diagnosed me.  

That is how silly this argument is!  There is no question that there are simple basic levels of diagnosis and there is an advanced level of diagnosis... however when you use signs, symptoms, patient history and a physical assessment to determine an appropriate level of care it is ludicrous to claim it is not a diagnosis!


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## VentMedic (Feb 11, 2010)

dave3189 said:


> Where does it indicate that a "diagnosis" has to reach some specific, (and yet unmeasurable) level of advanced diagnostic/clinical medicine to be considered such?
> 
> According to your contention, an attending at the ED who treats an elderly woman from a fall who scans her and finds a hip fracture isn't diagnosing her? How does he know that she doesn't have osteoporosis? According to your theory, the Doc is just treating the symptoms of the disease? What you fail to realize is there is always another layer of diagnostic speciality that a patient can be referred to.
> 
> ...


 
Do you think any of these doctors were looking for only one diagnoses bases soley on the obvious?   If you had read my previous post you would have noticed my comment about an ED have several different diagnoses to work from and does not pigeon-hole him/herself into one.

Do you know how differently a CCT, Flight or Specialty team might treat the same patient brought to the ED by EMS based on a couple of lab values?  What about the obvious OD?  Do you think a CT Scan finding of a CVA might change the "OD" diagnosis or at least add to it?


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## dave3189 (Feb 11, 2010)

You seem to think that a diagnosis has to be the ultimate, final, significant factor which is ultimately responsible for the disease, injury or illness.  That is not the case.  

I can take one scenario of an MVC and give several examples of correct diagnosis.

-EMT arrives and diagnoses bilateral femur Fractures

-Medic arrives and diagnosis hypoperfusion-Hypovolemia (starts fluids)

-ED Doc does CTs and finds multiple fractures

-Later Blood tests reveal Bone cancer (contributing factor to the multiple fractures)

These are all correct levels of diagnosis, although clearly at different levels


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## CAOX3 (Feb 11, 2010)

I recognise a problem then if possible I treat the symptoms associated with the underlying problem.   

If thats diagnosing then so be it, I dont get overly concerned with the definition.


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## Veneficus (Feb 11, 2010)

VentMedic said:


> So a sign and a symptom is essentially a diagnosis?
> 
> 
> 
> ...


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## 46Young (Feb 11, 2010)

Veneficus said:


> VentMedic said:
> 
> 
> > So a sign and a symptom is essentially a diagnosis?
> ...


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## Veneficus (Feb 11, 2010)

46Young said:


> Veneficus said:
> 
> 
> > I almost aspirated my dinner after reading the last part :lol:
> ...


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## 46Young (Feb 12, 2010)

Veneficus said:


> 46Young said:
> 
> 
> > careful now, who the hell could possibly dx that B)
> ...


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## VentMedic (Feb 12, 2010)

46Young said:


> I almost aspirated my dinner after reading the last part :lol:


 

That wasn't part of my quote. That was Veneficus. But then he believes there is not need to look for a cause to the CHF as it is an end all diagnosis. That however is also how some look at a "diagnosis" as well and go with what fits to initiate a protocol. 

Look at the examples we have had in the scenarios and in the news. If it doesn't "fit" one of the working diagnoses listed in someone's protocols, too bad. Look at the example of the high school football player that died. Too often Paramedics try to fit the patient into a "work diagnosis" rather than allowing the symptoms to lead them to other possibilities. How many here feel they MUST make a diagnosis to run a specific protocol? Or, if it doesn't fit, it is "BLS'd" in with or without a Paramedic even if the patient is truly sick. 



46Young said:


> Just use the cookbook. Can't go wrong with that


 
Thank you. That is exactly my point. As long as you can get a couple of symptoms to fit to run a protocol, it all good...except for the patients that didn't get the proper treatment because they were "fitted" into one recipe. 



> Originally Posted by *VentMedic*
> 
> 
> _How much is "assumption"?_





Veneficus said:


> A lot more than you seem willing to admit I'd wager.


I asked the question "how much is assumption" since I do know a large part is based on it. Much becomes a guessing game as evidenced on scenario threads as some state "looks like something I saw once" or "I heard that maybe this" rather then knowing how to actually make the diagnosis of that disease.



> For some reason I just don’t feel the need to constantly point out what basic healthcare providers can’t possibly know after their few hours of training.


 
As far as the EMT vs Paramedic comment, the last time I looked there is a difference in the levels. But yet some do believe they are at the same level or better than any doctor. It is those I would caution to know their limitations and continue assessing since what you think you "see" may have much more to the story and may not be just "BLS".

Both of you are missing the message in my posts since I stated the use of preliminary or working diagnosis when referring to the Paramedic many times. My point is not to confuse a symptom as an end all diagnosis as there may be many other symptoms or "working diagnoses" that could be made or found.


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## ivanh3 (Feb 12, 2010)

I think EMTs/medics diagnose accurately quite frequently. However, some times we just address our symptoms and do follow up later. This is all part of the growth that happens during a career. I think some people get a bit caught in the cookie cutter vs critical thinking aspect of the job. There can be both. Algorithms can be great in the beginning and when there is a need for speed. Likewise with critical thinking. One is not mutually exclusive of the other.


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