Medical diagnosis and its nature

Introduction

Diagnosis is one of the most important concepts in medicine, as its correctness significantly influences the success of treatment and prevention efforts, and ultimately the patient’s quality of life and life expectancy. However, contemporary medical science and clinical practice encounter a great variety of interpretations regarding the basic nature and structure of medical diagnosis, as well as the approaches to diagnosis. Concepts such as clinical diagnosis, differential diagnosis, provisional diagnosis, disease diagnosis, and patient diagnosis are commonly used in medicine, but they are not well defined and often contradict each other. In the meantime, diagnoses in clinical situations often fail to meet the basic criteria of the diagnostic concept.

Contemporary medical diagnostic theory and practice face significant uncertainties and inconsistencies that hinder diagnostic quality and efficiency. The regulatory authorities, striving for absolute standardization, have overlooked the critical topic of “diagnosis”. Currently, the only existing document pertaining to this matter is Order No. 4 of January 3, 1952, issued by the USSR Ministry of Health.¹

The theory of diagnosis, including its types and rules of formulating, carries significant medical and regulatory implications for healthcare providers in addition to its crucial role in medical treatment. Could not the basis for claims to a doctor be the correctness of diagnosis, its comprehensiveness and relevance, and the clarity of wording? Varying judgments, approaches to the diagnosis methodology, its formulation, and construction rules can distort information, lead to varying interpretations, and potentially result in legal action against the doctor, even if the content is accurate. This raises the question of which regulatory system and understanding of diagnosis a doctor should rely on in his or her daily practice.

This article aims to reconcile the theoretical understanding of diagnosis with its practical implementation.

Background

Currently, the medical literature generally accepts and reflects four types of diagnosis: clinical, autopsy, forensic, and epidemiological [1]. This paper excludes autopsy, forensic, and epidemiologic diagnoses because of their indirect relationship to maintaining human health. For this reason, only medical diagnoses in the context of health maintenance will be the subject of discussion here.

The origins of medical diagnosis can be traced back to the beginning of medicine itself. However, the pre-scientific interpretation of diagnosis was very different from its current connotation. Therefore, the authors believe it impractical to consider pre-scientific aspects of diagnosis in this context and will instead focus on the theory of diagnosis in the 20th and 21st centuries.

The Soviet and Russian medical literature offers similar yet distinct approaches and definitions of diagnosis. The current standards for the structure and substance of clinical diagnosis were formulated and suggested by pathologic anatomy researchers led by Davydovsky and later elaborated on by Avtandilov [2]. The experts who developed and implemented the diagnostic standards had medical but not clinical expertise. This could potentially hinder understanding of the diagnostic phenomenon, including its substance and structure. This has created a gap in the diagnostic theory regarding rules and procedures for diagnosing, along with the formulation, classification, and formalization of diagnoses. This discrepancy in the criteria for formulating a diagnosis and describing its substance becomes especially evident when comparing clinical and physiological definitions of diagnosis. For example, Vasilenko defines a diagnosis in the following way: “Diagnosis is a brief medical opinion on the nature of a disease and the patient’s condition in light of contemporary medical science. It is important to distinguish between diagnosis morbi, which is the designation of the disease based on a widely accepted classification, and diagnosis aegroti which identifies the patient’s individual characteristics” [1].

A slightly different definition can be found in the Bol’shaia Meditsinskaia Entsiklopediia (the Big Medical Encyclopedia, BME) edited by Pokrovsky: “Diagnosis is a medical opinion pertaining to the individual’s pathological health condition, the presence of disease (or injury), or the cause of death as outlined by the widely accepted classifications and nomenclatures of diseases. The diagnosis may also encompass specific physiological states, such as pregnancy or menopause, etc., and inferences related to epidemiological blocks. Ideally, a diagnosis should capture the individual’s unique disease characteristics, such as his or her individual response, age, constitution, lifestyle, etc. A ‘patient diagnosis’ as opposed to a ‘disease diagnosis’ is used in this scenario. ‘Patient diagnosis’ is the highest level of medical diagnosis. The conclusion drawn from the disease nature, primary manifestations, and progression, as presented in the clinical epicrisis of the patient’s medical history, best meets the criteria for accurate diagnosis” [3].

Developing this understanding of diagnosis, Vasilenko identifies the following types based on:

1. Method of construction:

a) similarity diagnosis;

b) differential diagnosis;

c) synthetic or comprehensive diagnosis;

d) diagnosis through observation;

e) diagnosis based on the patient’s response;

2. Timing of diagnosis:

a) early;

b) late;

c) retrospective;

d) postmortem;

3. Degree of validity:

a) provisional;

b) definitive;

c) doubtful.

These approaches to understanding the diagnosis have remained largely unchanged to date. For example, Zaratyants defines a diagnosis as follows: “A brief medical opinion on the individual’s medical condition, disease (or injury), or cause of death formalized according to current standards and expressed in terms suggested by current classifications and nomenclatures of diseases; the diagnosis may also incorporate specific physiological states, such as pregnancy or menopause, and post-disease conditions). Additionally, it may involve inferences relating to epidemiological blocks” [4].

The contemporary understanding of diagnosis is outlined in the Fundamentals of Russian National Health Care, which declares: “A diagnosis is made by a doctor following a thorough examination of a patient, utilizing medical terminology. It is a medical conclusion regarding the patient’s disease (condition), or cause of death. Diagnosis generally comprises details about the underlying disease or condition, concurrent diseases or conditions, and any complications caused by the underlying and concurrent diseases”.² This definition is primarily legal and does not encompass all medical considerations, yet it holds substantial importance for doctors in establishing the focus and forms of diagnosis.

The additions proposed by Vasilenko for the classification of diagnoses, which are present in contemporary medical literature, serve solely to clarify rather than being of fundamental importance. The researchers from Gomel Medical University suggest expanding the classification of diagnoses based on diagnostic reliability (misdiagnosis), timing (preclinical diagnosis), and the method of construction (intraoperative diagnosis).

The above definitions presented by scientists from various medical schools and specialties, at different times, contain numerous methodological errors, contradictions, and inaccuracies. These issues prevent them from meeting the standards of contemporary science and practice.

One issue to address is the imprecise use of terminology, leading to inaccuracies and lack of clarity in conveying ideas.

First, “diagnosis is a brief medical opinion”. What is it? Is this simply a format outlined in Order No. 4 of 1952 issued by the USSR Ministry of Health (a primary disease, complication, and concomitant diseases)? How brief is it? Does the diagnostic objective dictate its completeness or brevity? Assuming that the diagnosis is a brief medical opinion, does that mean that the diagnosis has no absolute meaning? If it is only a summary, is it always incomplete? Finally, if a diagnosis is considered to be a doctor’s opinion, what then constitutes comprehensive information?

Second, “diagnosis is a medical conclusion pertaining to the individual’s pathological health condition, the presence of a disease (or injury) …”. What is this? The pathological health condition presented here is distinct from pre-existing diseases. What is encompassed within the notion of “pathological health condition” if it does not incorporate the concepts of “disease” or “injury”? How should a pathological health condition be described?

Third, the thoroughness of the patient’s examination is excessive. When the term “thoroughness” is used philosophically to describe the patient’s examination, it implies a reasonable approach that includes all aspects that need to be examined. However, when referring to a specific phenomenon such as a patient’s health, the term loses its meaning as it implies that the doctor should develop and perform a method of “thorough” examination for each patient, which is unfeasible.

The use of vague or context-insensitive terms in many definitions creates ambiguity surrounding the concept of “diagnosis” itself. For example, Vasilenko’s definition says: “diagnosis is a ... opinion on the nature of a disease...”. As known, it is usually a scientist, a researcher, who determines the nature of a phenomenon, including that related to an unrecognized disease. At the very least, it is odd enough to set such a goal for a routine diagnostic examination. If a disease has been identified, its nature is presumed to be known, and the diagnosis should reflect only the name of the disease, its stage of development, severity, etc. Assuming that the nature of the disease varies among different organisms, the designation of the disease becomes meaningless.

Furthermore, the wording “the diagnosis may be specific physiological states” raises the question of what is meant by “may be”. When may they not? What is meant by the term “specific physiological states”? Have they been listed anywhere?

Another problem is that the formulation and definition of diagnoses fail to recognize a disease as a process rather than a static condition and that this process involves a series of pathological, adaptive, and adaptive-recovery processes.

It would be pointless to examine the other numerous shortcomings of contemporary diagnostic theory and practice. One must acknowledge that the multitude of inaccuracies, ambiguities, contradictions, and imperfections in formulating the concept of diagnosis renders the definition inaccurate and its usability questionable. Currently, the term “diagnosis” is understood more by intuition than by exact scientific definition. All of the above highlights the necessity to obtain an accurate scientific understanding of the phenomenon of diagnosis, useful for practical purposes, along with its various types and forms.

Implications and Scope of Diagnosis

Obviously, the concept of diagnosis relies on underlying assumptions; it is not an original concept in itself. All the definitions of diagnosis previously discussed were taken for granted, merely summarizing their understanding and conventions within medical practice, but failed to elaborate on how the concept actually evolved. Based on this, the aim is to examine the implications and origins of the diagnosis phenomenon.

Goals of Medicine and Doctor’s Objectives

According to the WHO, the goal of medicine is to prolong the patient’s life and maintain its quality³. This definition implies that the goal should be universally applicable to a vast population. Obviously, the WHO definition pertains to the absolute life expectancy, i.e. expressed in years, while quality of life refers to the potential for a life that enables individual self-actualization beyond mere survival. However, abstract generalizations, such as those regarding entire nations or the human race, cannot be directly applied to an individual person. When considering the goals of medicine for any given patient, they are established by combining the general goals declared by the WHO with the specific individual needs and abilities. Thus, the doctor’s objective is to work with the patient to identify, formulate, and achieve the patient’s medical goal. The difference between the specific goal of a patient’s medical care and the general goal of medicine lies in the ability to achieve the overarching goal specified by the WHO while considering the patient’s internal and external circumstances. In other words, the WHO’s overarching objective is considered on an individual basis, factoring in the patient’s personal beliefs, physiological capabilities, and social context.

This begs the question of how medicine can help achieve these goals. Obviously, the primary concern in this matter is to maintain good health. Even without further analysis, it is indisputable that the quality and length of an individual’s life are highly dependent on overall health. In fact, if one accepts the concept of “health” as the optimal functioning of an organism, then its lifetime and performance cannot be more than ideal, i.e. the length and quality of life are based on maintaining health. That is to say, the goal of medicine is to maintain the patient’s health as evidenced by the length and quality of life.

Health Is Inherent to Living Organisms

As previously mentioned, health is a fundamental concept of medicine, as its objective is to maintain human health. Even a priori, health is understood to be the ability of an organism to function according to its species’ norms.

The WHO defines health as a state of complete physical, mental, and social well-being, beyond the mere absence of illness or physical impairments. That is, the WHO postulates health to be largely subjective, relying on “well-being” assessments. Social, mental, and even physical well-being translates to an individual’s overall sense of comfort. However, does not the absence of well-being or satisfaction drive the desire for creation and innovation, embodying self-actualization as a fundamental aspect of human nature?

What is the definition of “health” according to the national medical science? In his article on health (refer to the BME), Frolov notes that the concept itself serves as an unattainable ideal; it is essentially an abstract notion when it comes to the human population and its general well-being. In practice, an individual’s health is defined as a body state that falls within certain limits in relation to absolute health [5]. However, it is important to note that these limits are mostly statistical and not substantive. This implies that one’s comprehension of practical health is reliant on certain conditions.

Many scientists have expressed skepticism regarding the concept of health, with some maintaining their reservations to this day. For example, Ramsay stated: “Every individual has some form of disability, and their overall health depends on the extensive network of hospitals and clinics”.

However, it is important to recognize that health is an innate attribute of the body, similar to the functionality of a machine.

Expressing health in terms of external variables is not a definitive statement of health, but rather a means of identifying ill health. The variability of variables (e.g., pressure, temperature, etc.) for each individual is often associated with various factors beyond the scope of health and illness boundaries. The organism’s adaptability and reactivity may constitute important factors in this context. Therefore, it is not in the external manifestations, but in the inherent qualities of the organism that the definition of health should be sought. So the following definition can be suggested: health refers to the state wherein an organism fulfills its physiological functions completely while maintaining internal and external homeostasis. This state can be sustained indefinitely under normal environmental conditions. Normal environmental conditions mean the conditions in which the phenotype has developed and currently exists.

According to this definition, “health” and “ill health” in the medical sense pertain solely to the organism and do not encompass social or psychological aspects of health, which are the purview of separate fields of study and social institutions.

The opposite of health is ill health, which refers to diseases and impairments of bodily functions. The transformation between the two is mutual.

Currently, medical science focuses on the concept of health, whereas practical medicine primarily addresses ill health, with the ultimate aim being achieving good health. However, practical medicine, which addresses the identification and management of health issues, should acknowledge that nobody, including doctors, can replace the organism’s role in maintaining good health. Identifying the processes of ill health, combating the causative factors, and partially restoring lost functions are all that practical medicine has learned. Maintaining health, even when considering the loss of certain bodily functions, is solely determined by the organism itself. Therefore, it is crucial for practitioners to always consider the nature of health, the factors that contribute to its maintenance, and the ways in which it can be achieved.

Ill Health Is the Focus of Diagnosis

As stated above, the goal of medicine is to achieve and maintain human health. This can be achieved by preventing or minimizing ill health. Maintaining health involves eliminating factors that contribute to ill health, preventing diseases and dysfunction, and minimizing the damage caused by ill health and injuries, since ill health is manifested in the forms of diseases and dysfunctions. Medicine is therefore aimed at preventing and managing diseases and dysfunctions. Injury prevention is not within the scope of medicine’s objectives, as it is deemed a social issue.

To effectively prevent and manage diseases and dysfunctions, it is critical to understand their nature and mechanisms. Diagnosis requires knowledge of how they manifest, as well as their underlying causes and preconditions.

Diagnosis in the Context of Contemporary Medicine

Based on the understanding of the focus of diagnosis, let us define it strictly, examining various aspects of existence for this purpose.

Functions of Diagnosis

In current medical practice, clinicians typically prioritize formulating a clinical diagnosis for regulatory purposes rather than emphasizing its communication to a patient. This is embodied in specific language and diagnosis code intended solely for medical professionals. This indicates that within contemporary clinical practice, the diagnosis is conceived as a report on a doctor’s work. However, this is an inaccurate understanding of the true function of diagnosis. Diagnosis is the final stage of the diagnostic process, and it is evident that the diagnostic process itself as a type of healthcare service should prioritize the patient’s will and desire. The diagnosis serves as a report to the patient on the achievement of the objective, with its primary function being to provide accurate, exhaustive, true, and comprehensible information to the patient on his or her health status, which is of interest to him or her.

Since today’s diagnosis and treatment often involve more than one medical specialist, another essential function of diagnosis is to communicate and store the necessary information for all participants in the process. Other functions may be artificially attributed to diagnosis from external sources such as national statistical recording or economic assessment of medical expenses. However, these functions are not inherent in the diagnosis itself and can be carried out by doctors due to external initiatives.

Grounds for Diagnosis

Now that the functions of diagnosis have been defined, let us look at the grounds for diagnosis, or to be more precise, its triggers. The ethical paradigm of contemporary medicine is the patient’s free will, his or her right to dispose of his/her life and health except in situations where he or she can cause harm to others. Consequently, interventions in human health must solely be based on the patient’s desire. However, in situations where the patient is unable to realize his or her actions, the doctor must adhere to the general principle of maintaining human health. Thus, the grounds for diagnostics and diagnosis should be based on the patient’s clearly expressed will. The diagnostic outcome is determined by a diagnosis resulting from the patient’s diagnostic goal. That is, the diagnosis results from the patient’s goal. Other grounds for diagnosis may exist, such as emergencies or legal requirements.

What is included within the term “ground for diagnosis”? This can be understood as the patient’s initiative, clearly expressed will, the precisely defined focus of diagnosis (the patient’s goal), and the scope of the examination.

How is this achieved today? Typically, a doctor initiates a diagnostic process based on the patient’s complaints and uses his or her own discretion to establish and build upon diagnostic goals. However, patients may frequently express dissatisfaction with the doctor’s qualified efforts to establish a diagnosis. This discrepancy arises from the doctor’s subjective assessment of the patient’s expectations, as determined through complaints, versus the patient’s actual goal. It is vital to distinguish accurately between the patient’s goal, the reason for the visit, and complaints. Failure to do so may result in the doctor’s inability to understand the patient’s expectations and ensure his or her satisfaction. The patient’s goal in relation to diagnosis involves identifying the focus of diagnosis, such as the risk of disease, the presence of ill health (disease or functional insufficiency), and the risk of complications. However, it is important for the doctor to make sure that the patient’s goal has been determined in a collaborative and accurate manner. This is accomplished through the coherent association of the patient’s complaints, the reason for the visit, the desired outcome, the coherence of symptoms reported, the precise formulation of complaints, the duration of symptoms, and other factors. The issue at hand is solely the doctor’s accurate comprehension of the patient’s actual goals. A wrong solution to this problem by the doctor leads to medical errors and the patient’s dissatisfaction.

The objectives for doctors in diagnosing a patient are determined by the patient’s goals. What are the objectives of prophylaxis? What are the objectives of establishing ill health? Or verifying a diagnosis already established by another doctor? Or the objectives of treatment? The doctor should actively participate in identifying and formulating the patient’s goal, and the diagnosis should reflect the reason for the visit, the patient’s goal, and complaints.

Since the patient is a recipient of the diagnosis, it should be communicated objectively and clearly, adhering to the principles and methods of medicine. However, it should also be comprehensible to the patient and other medical professionals involved in the patient’s care. Comprehensibility is not only the result of grammatical and stylistic correctness, but primarily the result of a logical conclusion to diagnosis.

Substance of Diagnosis

As previously stated, the focus of diagnosis centers on ill health, its origins, forms, and potential complications. Depending on the purpose of diagnosis, its substance may include risks of illnesses, early- or clinical-stage diseases or functional insufficiencies, and potential complications associated with the identified ill health condition. Risks refer to the influence of etiological factors, maladaptation, organic defects, and congenital or acquired conditions. Functional insufficiency is any disturbance of the external or internal functions of an organism. A disease complication should be considered as a new disease or functional insufficiency, with the underlying disease or functional insufficiency as an etiological cause. The concept of disease has been discussed in the article [6].

When considering the substance of the diagnosis, it is important to maintain continuity. If a disease, functional insufficiency, or risk of illness is identified, it is necessary for a treating doctor or other medical professionals to maintain a diagnostic history until the identified illness is resolved or results in death. In summary, obtained diagnostic findings and conclusions serve to supplement and modify the previously established diagnosis of a particular health condition.

The scope of diagnosis is likewise a crucial constituent of its substance.

The attainment of comprehensive diagnosis during routine medical care is hindered due to economic reasons. However, a comprehensive diagnosis is not necessary even for scientific purposes. As previously noted, the scope of diagnosis is influenced by the goals established between a patient and doctor and restricted by the patient’s preferences, medical resources, and limitations.

The focus of diagnosis is information about the risks of illness and its presence. Its quantity should be adequate to provide unambiguous answers to the questions posed. If the question relates to the risks of particular diseases, it is important to explain the reasons for selecting these particular diseases, to outline the methods used to identify the risks, to describe the nature of the risks, and to specify the health characteristics taken into account.

When identifying a disease or functional insufficiency, it is crucial to list the reasons for diagnosis and the specific processes that define the disease (or functional insufficiency). Additionally, it is important to mention the name of the disease (or functional insufficiency), indicate any other conditions that may influence the course of the identified disease and relevant health factors that may impact the course of the disease or its management. The inclusion of superfluous details in the diagnosis that have no justification, i.e. “just in case”, is unacceptable. Thus, a diagnosis lacking the necessary data or containing extraneous information cannot be considered correct.

In diagnosing a disease or functional insufficiency, it is essential to strictly observe the principle of “absorption” (9) of all present symptoms of the identified condition and ensure there is no unexplained absence of symptoms that should be present.

Requirements for Diagnosis

The concept of diagnosis is abstract, yet the actual diagnostic process is specific and has a clear start and endpoint, similar to any specific object. The formulation of diagnosis marks its initial stage, with subsequent events serving as the endpoint. The period of relevance in accordance with the relevant guidelines is the endpoint for the diagnosis of the disease risk assessment. Determining whether a condition is present or absent is based on the patient’s next diagnosis or subsequent visit for the same condition, which serves as the diagnostic endpoint. The diagnosis of an irreversible functional insufficiency signals the end of life, whereas a reversible one indicates the need for the next diagnostic examination. A disease diagnosis maintains relevance until its resolution.

It is evident that the state of ill health is an ongoing process and entails body changes, including those crucial for evaluating the patient’s health and ill health, which must be integrated into the diagnostic process. In this instance, the diagnosis is appropriately supplemented, thereby preserving its persistent relevance.

Comments on Diagnosis Definition

1) Accuracy Diagnostic accuracy can refer to three different states.

The first state represents a true reflection in the diagnostic formula of the significant processes occurring in the patient’s organism during disease, functional insufficiency, in risk assessment, adaptive capacity, and subclinical conditions.

The criterion for diagnostic accuracy applies in cases where there are reliable methods of detection. Accuracy is defined as the correlation between conceivable concepts and models, which reflect those concepts. Additionally, it requires the correlation between models in all essential aspects and those processes that occur in the organism.

The second state reflects a spectrum of possible processes occurring in the organism, including true ones, in its formula. This is ensured only if the methodology provides such an outcome of diagnostics.

The third state involves all diseases, functional insufficiencies, risks, adaptive capacities, and subclinical conditions that can be detected through guaranteed or probabilistic methods.

Therefore, accuracy is the precise selection and adherence to the diagnostic methodology. When discussing the methodology, one can refer to specific clinical recommendations and high-evidence methods. When clinical recommendations are not available or accessible, the diagnostic algorithm relies solely on the doctor’s knowledge. This may subsequently decrease the reliability of the outcome. Diagnosis should specify the methodology used. Verification of diagnosis can be confirmed through subsequent practical actions such as treatment, prevention, and prosthetic repair. If any inaccuracies are found, an amendment to the clinical diagnosis will be made. The accuracy of the diagnosis and description of the methods employed to make it are crucial for a diagnosing doctor and other doctors referring to the diagnosis.

2) Comprehensibility

When formulating a diagnosis, it is crucial to guarantee the unambiguous comprehension of the reflected information by others. This requires precise and correct use of unambiguous terminology. In addition, it is imperative that conclusions have a consistent logical flow and validity throughout the text.

3) Reproducibility.

Reproducibility is referred to as the state of the diagnostic formula where the same formula is obtained every time when the correct inference methods are used, based on the symptoms reflected in the diagnosis. Reproducibility can be compromised by the following:

• incorrect objectification and formalization of symptoms;
• incomplete identification of symptoms;
• inappropriate use of logical reasoning rules.

4) Completeness (necessary and sufficient to achieve the stated medical goals).

When establishing and forming a diagnosis, a doctor should consider the goals agreed upon with a patient. Avoidance of exceeding the predetermined goals is vital in ensuring patient-centered medical care. For the diagnostic report to attain its intended goal, it ought to convey only essential and objective information. The goals of diagnostic investigation, including its limitations, should be evident in diagnosis. Diagnosis should be sufficiently deep, meaning an examination should be thorough but not excessive, to ensure effective progress toward achieving the goals.

The nature of diagnosis implies the doctor’s opinion based on an unbiased evaluation of the patient’s health status in its entirety with reference to the predetermined goals.

Structure of Diagnosis

The structure of diagnosis embodies its focus, substance, and requirements. The current structure of diagnosis, approved by the Order of the USSR Ministry of Health in 1952 with subsequent amendments, requires a modern interpretation taking into account the above-mentioned factors. Based on this, the following structure of diagnosis has been proposed:

Diagnosis dated DD.MM.YYYY

Updated DIAGNOSIS dated DD.MM.YYYY

1. Ground for Diagnosis (Updated Diagnosis) ___________________________ (patient’s visit, medical emergency, court’s ruling)
2. Purpose of Diagnosis _____________________________ (specify a final purpose or purposes)
3. Physiological Characteristics __________________________
4. Methodological guidelines used _____________________________ (if different methodological approaches can be used, indicate those that were actually used)
5. Diagnosis ________________________________________________

(list in order of priority, following the goals defined above; present the diagnosis of risks by listing the investigated risks, identifying the specific risks, and providing a comprehensive list of diseases caused by these risks; if possible, indicate the probability of these diseases)

Diagnosis of a disease requires identifying its pathological, adaptive, and adaptive-recovery processes, categorizing them under the same nosology, and describing associated symptoms and potential complications. Additionally, the etiological cause of the disease must be identified, including the name of the nosology.

The diagnosis of functional insufficiency includes the identification of suggestive symptoms, associated processes, and adaptive recovery, the name of the specific insufficiency, its severity, and potential complications.

Definition of Diagnosis

Based on all of the above, a medical diagnosis can be defined in the following way.

A medical diagnosis is a doctor’s (or doctors’) written opinion that is accurate, comprehensible, and supported by evidence. It is formulated in accordance with current criteria for disease (functional insufficiency) risk and presence, as well as within the scope necessary and sufficient to achieve medical objectives set by the patient in collaboration with the doctor.

Diagnosis can be classified into two types: diagnosis of ill health such as a disease or functional insufficiency, and diagnosis of ill health risks. It is important to distinguish between these two types of diagnosis.

The diagnosis of ill health indicates the presence of previously unidentified diseases or functional insufficiencies.

The diagnosis of ill health risks involves identifying active etiological factors, defects in adaptive systems, congenital or acquired organic defects, and characteristics that increase the likelihood of disease or functional insufficiency.

The diagnosis should adhere to the aforementioned form.

Conclusion

The understanding of diagnosis proposed in this paper, including its substance and structure, will improve the quality of diagnostics and diagnosis, promote mutual understanding between patients and doctors, reduce diagnostic costs, and facilitate communication between doctors.

The article provides a scientific basis for the definition of diagnostics and diagnosis, while precisely outlining their focus, substance, scope, and structure.

Overall, this will inevitably improve the efficacy of disease prevention and treatment, advancing us toward realizing the primary objective of medicine: to enhance the patient’s quality of life and extend its expectancy.