A Brief Understanding How Diseases are Diagnosed, Treated and their Outcome.

 

Good morning to you dear Allan Lee.

Thank you for asking in the comment column the methods we use in the examinations, investigations, treatment of diseases and their outcome. Thank you, Dr Jasmine Keys, too for your other discussions in our WhatsApp chat group.

Firstly, to all who are non-medical friends, it took us at least 5 years to learn medicine in a medical school to earn an MD or an MBBS degree. Thus it is almost impossible to describe all the methods, treatment a doctor or a clinician uses, and how diseases are classified. This learning period also applies to all other alternative, complementary or integrated systems of medicine, not just in conventional allopathic medicine. Medicine is quite complicated.

But what I can do for you Allan and other readers in my blog is give you a very fast run-down on all the diagnostic methods, treatment regimen and protocol, outcome of investigations and treatment a physician, a surgeon or other medical specialist may use. After that, I shall then give a brief classification of diseases.

This will not just answer your question but also provide a general idea on the methods used in medicine for the information of non-doctors and other readers. Is that okay?

Let us have a look at how diseases are investigated and diagnosed.

But before I proceed, straight away I need to emphasize it is not necessary for a doctor to do all investigations I am going to describe below for him to come out with a diagnosis. Most of these examinations, especially lab tests and radiological imaging are not necessary. I need to stress that a skilful doctor does not require all these tests. If he (including she) is a good clinician, he would use his clinical acumen and judgement to come out with an accurate diagnosis without any lab or axillary support. In other words, a skilful doctor is a good diagnostician. Imagine a doctor working in the field isolated from all facilities, or one who works in a remote rural environment where lab, radiological or other support diagnostic facilities are unavailable. What is he going to do then without them? 

He must depend entirely on what the patient tells him, the patient's history, and the presentations (signs and symptoms) of the disease. We cannot depend on all these support diagnostic facilities I am going to briefly list  below.  Then we are not a good diagnostician with good clinical acumen. 

A doctor depending entirely on lab support is going overboard with diagnosis which in most cases are not necessary. The most important probably is taking a good medical history of the illness, conducting an appropriate clinical examination, and looking for signs and symptoms presented. We would already be able to come out with the diagnosis unless of course the disorder is asymptomatic such as diabetes, high blood pressure. In that case we need lab support to investigate and to measure.

Lab, radiological and other diagnostic support are only necessary for differential diagnosis when the disease presentations are not clear cut, mimic another disease or with mixed complications with other disorders. Most cases are quite clear cut from what the patient tells the doctor, together with further questioning by the doctor, and perhaps some simple examinations such as listening to body sounds (auscultation), palpations, and percussions. 

 

We shall now proceed to describe other support diagnostic examinations and tests available.  

Diagnosis:

The diagnosis of diseases involves a multifaceted approach that includes clinical examinations, radiological imaging, laboratory investigations, and other specialized diagnostic methods. The clinical examinations include history taking by gathering information about the patient's past illnesses, surgeries, medications, allergies, and family history. Then the patient’s social history may be needed to gather information about lifestyle factors such as smoking, alcohol consumption, diet, and occupational hazards.

We will then go into the symptom analysis where we questioned the patient about the nature, duration, intensity, and progression of symptoms.

After history taking, we do a physical or clinical examination by inspection and visual examination of the body for signs such as rashes, deformities, or swelling. We do a palpation using hands to feel for abnormalities such as lumps, tenderness, or organ enlargement. We then do a percussion by tapping on body surfaces to detect abnormalities in underlying structures based on the sound produced. If necessary, we listen to internal body sounds, such as heart, lung, and bowel sounds, using a stethoscope. This is called auscultation.  The doctor may look at vital signs such as measuring blood pressure, heart rate, respiratory rate, and temperature.

If necessary, we may need radiological investigations such as:

·         Chest X-ray: To detect lung conditions like pneumonia, tuberculosis, and lung cancer.

·         Abdominal X-ray to identify obstructions, perforations, and some kidney stones.

·         Skeletal X-ray may be needed to diagnose fractures, dislocations, and bone infections.

More advanced radiology may also be used such as:

·         Computed Tomography (CT) Scan may be requested to provide detailed cross-sectional images of body structures, useful for detecting tumours, internal injuries, and infections.

·         Magnetic Resonance Imaging (MRI) using magnetic fields and radio waves to produce detailed images of organs and tissues, particularly useful for brain, spinal cord, and musculoskeletal conditions.

·         Ultrasonography uses ultrasound that uses high-frequency sound waves to create images of internal organs, commonly used in obstetrics, cardiology, and abdominal investigations.

We also have nuclear medicine scans, for example:

·         Positron Emission Tomography (PET) Scan.

We use this to detects metabolic activity and is useful in cancer diagnosis. Then we also have bone scan for us to detect abnormalities in bone metabolism. This is useful in diagnosing bone cancer and infections.

Most used are all those laboratory investigations. Let us summarise their long list here without unnecessary details:

1. Blood Tests:

·         Complete Blood Count (CBC): Measures different components of blood, including red and white blood cells, haemoglobin, and platelets.

·         Blood Chemistry Panel: Assesses electrolyte levels, kidney function (BUN, creatinine), and liver function (AST, ALT).

·         Blood Glucose: To diagnose diabetes.

·         Lipid Profile: Measures cholesterol and triglycerides levels.

2. Urine Tests

·         Urinalysis: Detects urinary tract infections, kidney disease, and metabolic conditions like diabetes.

·         Urine Culture: Identifies bacteria causing infections.

3. Microbiological Tests

·         Cultures (Blood, Sputum, Throat, Stool): Identify pathogens causing infections.

·         Sensitivity Testing: Determines the susceptibility of bacteria to antibiotics.

4. Immunological Tests

Antibody Tests: Detects antibodies against infections like HIV, hepatitis, and autoimmune diseases.

Antigen Tests: Identifies specific antigens related to infections or conditions.

5. Genetic Testing

Karyotyping: Examines chromosomes for genetic abnormalities.

PCR (Polymerase Chain Reaction): Detects specific genetic sequences associated with diseases.

Other Diagnostic Methods Specialist Clinicians may use include:

1. Endoscopy

Gastroscopy: Visual examination of the stomach and upper GI tract.

Colonoscopy: Visual examination of the large intestine.

Bronchoscopy: Examination of the airways and lungs.

2. Electrodiagnostic Tests:

Electrocardiogram (ECG): Measures electrical activity of the heart, useful in diagnosing arrhythmias and myocardial infarction.

Electroencephalogram (EEG): Records electrical activity of the brain, used in diagnosing epilepsy and other neurological conditions.

Electromyography (EMG): Assesses the electrical activity of muscles, helpful in diagnosing neuromuscular disorders.

3. Biopsy

·         Fine Needle Aspiration (FNA): Extracts cells for examination, often used for lumps or masses.

·         Core Needle Biopsy: Removes a small cylinder of tissue for analysis, commonly used in breast and prostate examinations.

·         Excisional Biopsy: Surgical removal of a lump or suspicious area for examination.

4. Functional Tests

·         Pulmonary Function Tests (PFTs): Measure lung function, used in diagnosing respiratory conditions like asthma and COPD.

·         Cardiac Stress Test: Assesses heart function under stress, useful in diagnosing coronary artery disease.

5. Imaging-Guided Procedures

·         Fluoroscopy: Real-time moving X-ray images, often used during diagnostic and therapeutic procedures.

·         Image-Guided Biopsy: Uses imaging techniques (CT, ultrasound) to guide biopsy needles to precise locations.

Advanced and Specialized Diagnostic Techniques

1. Molecular Imaging

PET-CT scan: Combines PET and CT imaging to provide detailed information on both structure and metabolic activity.

2. Cytogenetic Analysis

Examines chromosomes for genetic conditions, often used in prenatal diagnosis and cancer.

3. Flow Cytometry

Analyses the physical and chemical characteristics of cells, used in diagnosing blood cancers and immune disorders.

The accurate diagnosis of diseases relies on a combination of these clinical, radiological, laboratory, and specialized diagnostic methods. Each method provides unique and valuable information that, when integrated, leads to a comprehensive understanding of a patient's health and the appropriate management of their condition.

Treatment of Diseases:

The treatment of diseases involves various approaches, each selected based on the type of disease, its severity, and individual patient factors.

Let us summarize the primary treatment approaches used, along with detailed information about each and the rationale behind their use.

Medical (Pharmacological) Treatments

1.      Medications:

·         Antibiotics: Used to treat bacterial infections by killing bacteria or inhibiting their growth (e.g., penicillin for strep throat).

·         Antivirals: Treat viral infections by inhibiting the development of the virus (e.g., oseltamivir for influenza).

·         Antifungals: Treat fungal infections by killing or stopping the growth of fungi (e.g., fluconazole for candidiasis).

·         Analgesics: Relieve pain (e.g., acetaminophen for headaches, opioids for severe pain).

·         Anti-inflammatory Drugs: Reduce inflammation and pain (e.g., ibuprofen for arthritis).

·         Chemotherapy: Uses cytotoxic drugs to kill or stop the growth of cancer cells.

·         Immunosuppressants: Reduce immune system activity to prevent organ rejection or treat autoimmune diseases (e.g., cyclosporine).

2.      Surgical Treatments: 

Curative Surgery:

1.      Tumour Resection: Removal of cancerous tumours to eliminate the disease.

2.      Appendectomy: Removal of the appendix to treat appendicitis.

Reconstructive Surgery:

1.      Joint Replacement: Replacing damaged joints to restore function (e.g., hip replacement for osteoarthritis).

2.      Plastic Surgery: Reconstruction of body parts after trauma or disease (e.g., breast reconstruction after mastectomy).

Minimally Invasive Surgery:

1.      Laparoscopy: Small incisions and specialized tools for procedures like gallbladder removal, reducing recovery time.

2.      Endoscopy: Internal examination and treatment using an endoscope, often used for gastrointestinal issues.

Radiation Therapy

1. External Beam Radiation: Directs high-energy beams at tumours to kill cancer cells.
2. Internal Radiation (Brachytherapy): Places radioactive material inside or near the tumour, allowing high doses of radiation to target cancer cells with minimal damage to surrounding tissue.

Physical and Rehabilitation Therapies

1. Physical Therapy:

·         Exercise Programs: Strengthening and flexibility exercises to improve movement and function, often used for musculoskeletal injuries.

·         Manual Therapy: Hands-on techniques to manipulate muscles and joints, helping to relieve pain and improve mobility.

2. Occupational Therapy

Adaptive Techniques: Training to perform daily activities independently despite physical limitations (e.g., using assistive devices for eating or dressing).

3. Speech Therapy

Communication Skills: Helping patients with speech impairments to improve their speaking abilities (e.g., after a stroke).

Psychotherapy and Counselling

1. Cognitive Behavioural Therapy (CBT)

Behaviour Modification: Helps patients identify and change negative thought patterns and behaviours, effective in treating depression and anxiety.

2. Supportive Counselling

Emotional Support: Provides a safe space to discuss feelings and challenges, helping to manage mental health conditions.

Lifestyle and Behavioural Interventions

1. Dietary Changes

Nutritional counselling: Guides patients on healthy eating to manage conditions like diabetes, heart disease, and obesity.

2. Exercise Programs

Regular Physical Activity: Helps improve overall health, manage weight, and reduce the risk of chronic diseases.

3. Smoking Cessation

Behavioural Support and Medications: Aids in quitting smoking, significantly reducing the risk of respiratory and cardiovascular diseases.

Alternative and Complementary Therapies

1. Acupuncture

Pain Relief: Involves inserting thin needles into specific points on the body to relieve pain and improve overall well-being.

2. Herbal Medicine

Natural Remedies: Uses plant-based substances for therapeutic purposes, often integrated with conventional treatments.

Advanced and Experimental Treatments

1. Gene Therapy

Genetic Correction: Involves inserting, altering, or removing genes within a patient’s cells to treat genetic disorders (e.g., using CRISPR for genetic diseases).

2. Stem Cell Therapy

Regenerative Medicine: Uses stem cells to repair or replace damaged tissues and organs, with potential applications in treating conditions like Parkinson's disease and spinal cord injuries.

3. Immunotherapy

These various approaches are used to tailor treatment plans based on the specific needs of the patient and the nature of the disease. The goal is to provide effective,

The outcomes of clinical examinations, investigations, and treatments vary depending on several factors, including the type of disease, the specific method used, and individual patient characteristics. Below is an overview of the typical outcomes, accuracy, specificity, and success rates associated with these approaches.

Having described the above, you may like to ask what about the outcomes of all these clinical examinations and investigations?

I shall try to briefly answer from my experience as a clinician and a former senior medical researcher.

1. Clinical Examinations

Accuracy and Specificity: Physical examinations are crucial for initial assessments and can provide immediate insights into a patient's condition. However, their accuracy and specificity can be limited by the examiner's expertise and the subtlety of the symptoms.

Outcomes: Clinical examinations often guide the need for further testing. They are effective in diagnosing obvious conditions like fractures, infections, and acute illnesses.

2. Radiological Investigations

X-rays: Highly specific for detecting fractures, lung infections, and certain tumours. However, they have limitations in detecting soft tissue abnormalities.

CT scans: Provide detailed images and are highly accurate for detecting internal injuries, tumours, and infections. They are widely used due to their high diagnostic value.

MRI: Offers excellent specificity and accuracy for soft tissue evaluation, including brain, spinal cord, and joint assessments. It is invaluable for detailed imaging without radiation exposure.

Ultrasound: Non-invasive and accurate for visualizing organs and blood flow. It is particularly effective in obstetrics, cardiology, and abdominal assessments.

Nuclear Medicine: Highly specific for detecting functional changes in tissues, such as cancerous growths or bone metabolism abnormalities.

3. Laboratory Investigations

Blood Tests: Generally accurate and specific for detecting a wide range of conditions, from infections to metabolic disorders and organ function.

Urine Tests: Effective for diagnosing urinary tract infections, kidney diseases, and metabolic conditions.

Microbiological Tests: Cultures and sensitivity testing are very specific and accurate for identifying pathogens and determining appropriate treatments.

Genetic Testing: High specificity for identifying genetic disorders and predispositions, although some tests may have limitations in predictive value.

Outcomes of Treatments

1. Medical (Pharmacological) Treatments

·         Antibiotics/Antivirals/Antifungals: Generally, highly effective when used appropriately. Resistance can be an issue, reducing effectiveness.

·         Analgesics and Anti-inflammatory Drugs: Effective for pain and inflammation management. Success depends on the underlying condition and proper use.

·         Chemotherapy: Can be highly effective in treating cancers, though it often comes with significant side effects. Success rates vary based on cancer type and stage.

·         Immunosuppressants: Effective in preventing organ rejection and treating autoimmune diseases, though they increase infection risk.

2. Surgical Treatments

·         Curative Surgery: Often highly successful for localized conditions like appendicitis or certain cancers. Success depends on disease stage and surgical precision.

·         Reconstructive Surgery: Generally effective in restoring function and appearance, though outcomes can vary based on the complexity of the surgery and healing processes.

·         Minimally Invasive Surgery: Typically associated with faster recovery times and lower complication rates compared to open surgery.

3. Radiation Therapy

External Beam and Internal Radiation: Highly effective for many types of cancer. Success rates depend on cancer type, stage, and precision of radiation delivery.

4. Physical and Rehabilitation Therapies

·         Physical Therapy: Generally successful in improving mobility, reducing pain, and enhancing recovery from injuries and surgeries.

·         Occupational and Speech Therapy: Effective in helping patients regain independence and communication skills after injury or illness.

5. Psychotherapy and counselling

CBT and Supportive counselling: Proven effective for treating mental health conditions like depression and anxiety. Success rates vary based on patient engagement and the severity of the condition.

6. Lifestyle and Behavioural Interventions

·         Dietary Changes and Exercise Programs: Highly effective in managing chronic conditions like diabetes, heart disease, and obesity when adhered to.

·         Smoking Cessation: Significantly reduces the risk of respiratory and cardiovascular diseases, with success rates improved by combined behavioural and pharmacological support.

7. Alternative and Complementary Therapies

Acupuncture and Herbal Medicine: Can be effective for certain conditions like chronic pain and anxiety. Outcomes can vary widely based on practitioner expertise and individual responses.

8. Advanced and Experimental Treatments

Gene Therapy and Stem Cell Therapy: Show promise in treating genetic and degenerative conditions. While still largely experimental, they have demonstrated significant success in clinical trials.

Immunotherapy: Effective for various cancers and some autoimmune diseases, often providing new options in conventional treatments. The accuracy, specificity, and success of these examinations, investigations, and treatments generally provide positive outcomes, but they can vary based on the disease, the method used, and patient factors. The combination of advanced diagnostic tools and personalized treatment plans has greatly improved the ability to diagnose and effectively treat a wide range of diseases, leading to better patient outcomes and quality of

Diseases can be classified in various ways depending on different criteria such as aetiology, pathophysiology, affected systems, and duration. Here is a comprehensive classification of diseases:

1. By Aetiology (Cause)

·         Infectious Diseases: Caused by pathogens such as bacteria, viruses, fungi, or parasites. Examples include tuberculosis, influenza, and malaria.

·         Non-Infectious Diseases: Not caused by pathogens.

·         Genetic Diseases: Result from abnormalities in an individual's genetic makeup. Examples include cystic fibrosis and Down syndrome.

·         Nutritional Diseases: Caused by dietary deficiencies or excesses. Examples include scurvy (vitamin C deficiency) and obesity.

·         Environmental Diseases: Result from exposure to harmful substances or environmental factors. Examples include asbestosis and lead poisoning.

·         Occupational Diseases: Related to specific types of work. Examples include silicosis (from inhaling silica dust) and carpal tunnel syndrome.

·         Idiopathic Diseases: Diseases with no identifiable cause. Examples include idiopathic pulmonary fibrosis and idiopathic thrombocytopenic purpura.

2. By Pathophysiology (Mechanism)

·         Inflammatory Diseases: Characterized by inflammation. Examples include rheumatoid arthritis and inflammatory bowel disease.

·         Neoplastic Diseases: Involve abnormal cell growth, leading to benign or malignant tumours. Examples include breast cancer and melanoma.

·         Degenerative Diseases: Characterized by the progressive degeneration of tissues. Examples include Alzheimer's disease and osteoarthritis.

·         Metabolic Diseases: Affect metabolic processes. Examples include diabetes mellitus and hyperthyroidism.

·         Autoimmune Diseases: The immune system attacks the body's own tissues. Examples include lupus and multiple sclerosis.

·         Genetic and Congenital Diseases: Present at birth due to genetic mutations or developmental issues. Examples include congenital heart defects and haemophilia.

3. By Body System

·         Cardiovascular Diseases: Affect the heart and blood vessels. Examples include coronary artery disease and hypertension.

·         Respiratory Diseases: Affect the lungs and respiratory tract. Examples include asthma and chronic obstructive pulmonary disease (COPD).

·         Gastrointestinal Diseases: Affect the digestive tract. Examples include Crohn's disease and peptic ulcers.

·         Neurological Diseases: Affect the brain and nervous system. Examples include epilepsy and Parkinson's disease.

·         Endocrine Diseases: Affect hormone-producing glands. Examples include diabetes and thyroid disorders.

·         Musculoskeletal Diseases: Affect muscles, bones, and joints. Examples include osteoporosis and rheumatoid arthritis.

·         Renal and Urinary Diseases: Affect the kidneys and urinary system. Examples include chronic kidney disease and urinary tract infections.

·         Hematologic Diseases: Affect the blood and blood-forming organs. Examples include anaemia and leukaemia.

·         Dermatologic Diseases: Affect the skin. Examples include eczema and psoriasis.

4. By Duration and Course

• Acute Diseases: Have a sudden onset and a short course. Examples include the common cold and acute appendicitis.
• Chronic Diseases: Persist for a long time, often for the patient's lifetime. Examples include chronic obstructive pulmonary disease (COPD) and diabetes.
• Subacute Diseases: Have characteristics that are between acute and chronic. Examples include subacute bacterial endocarditis.
• Recurrent Diseases: Characterized by periods of remission and relapse. Examples include multiple sclerosis and herpes simplex infections.

5. By Severity

·         Mild Diseases: Cause minor discomfort and often resolve without treatment. Examples include the common cold and mild allergies.

·         Moderate Diseases: Cause significant discomfort or impairment but are usually manageable with treatment. Examples include moderate asthma and controlled hypertension.

·         Severe Diseases: Cause significant disability or are life-threatening. Examples include severe sepsis and advanced cancer.

6. By Mode of Transmission (for Infectious Diseases)

·         Communicable Diseases: Spread from person to person or from animals to people. Examples include influenza and HIV/AIDS.

·         Non-Communicable Diseases: Not spread from person to person. Examples include most genetic and chronic diseases like diabetes and heart disease.

7. By Response to Treatment

·         Curable Diseases: Can be completely eradicated with treatment. Examples include bacterial infections treated with antibiotics and some cancers caught early.

·         Incurable Diseases: Cannot be completely cured, though treatment may manage symptoms and improve quality of life. Examples include Alzheimer's disease and certain chronic conditions like rheumatoid arthritis.

8. By Epidemiological Characteristics

·         Endemic Diseases: Regularly found in a certain area or population. Examples include malaria in certain tropical regions.

·         Epidemic Diseases: Occur in excess of what is normally expected in a community or region. Examples include the Ebola outbreak in West Africa.

·         Pandemic Diseases: An epidemic that has spread over several countries or continents, usually affecting many people. Examples include COVID-19 and the 1918 influenza pandemic.

These classifications help healthcare professionals understand, diagnose, and treat diseases more effectively by considering various aspects such as cause, affected systems, severity, and response to treatment. Each classification provides valuable insights that guide clinical decision-making and public health strategies.

I have given a very brief outline, yet comprehensive description of most of the areas we do in medicine for the diagnosis and treatment of diseases for lay readers to understand for their general education.

Unfortunately, not many doctors know these. Most doctors are unaware of all of them that are available, including specialists who are confined to their own areas of medicine, and they may not use many of these diagnostic areas, except the usual common ones, like history talking, looking for signs and symptoms, auscultation, percussion, and palpation, besides X-rays and other radiological imaging where all doctors ought to know.  

Hope this helps. Remember what I wrote here:

The Origin and Purpose of the Soul. 

https://scientificlogic.blogspot.com/2024/

Finally, it is the soul that controls all the chemistries and the health in your body, not the doctor, anyone, or anything else.  

So, take care. 

Lim jb