Thursday, April 15, 2010

After Reading Chapters 4, 5, and 6:


What is meant by the term “differential diagnosis?” What is the benefit/drawback of this term?

32 comments:

  1. This is Connor Townsend.

    Differential diagnosis is when the doctors would use when diagnosing patients. Instead of settling on one possibility for a patient's problem, doctors will think of numerous possibilities and write them all down, due to the large number of variables in medicine. The benefit of this is that with many possibilities, the doctor won't just settle on one which could be the wrong one, which could lead to improper treatment. All bases are mostly covered.

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  2. Because medicine is such an inexact and imperfect science, differential diagnosis is a technique used by doctors to diagnose patients, giving various different diagnosis to allow for error and multiple treatments. Each patient, doctor and disease is slightly different, making it impossible to have only one exact ailment and one proper remedy, so in order to take in all possibilities, after examining a patient a doctor will write down several different diagnosis depending on the specific age, gender and symptoms of the patient. Differential diagnosis is beneficial because it allows for the unique ailments and symptoms of each patient, and it does not lock a patient into a treatment that may not be suitable. I don't think there are any drawbacks to the procedure of differential diagnosis, because it can never hurt to be open to more than one possibility.

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  3. The "differential diagnosis" is a process used by doctors to try to deal with the variability and inexact nature of medicine. Since there are so many variables involved in a diagnosis and treatment, a doctor will not simply identify the exact disease that a patient has. Instead, the doctor will identify multiple possibilities and then run tests to eliminate some of the diseases and ultlimately choose an illness and course of treatment. This term/practice is beneficial because it reduces the chances of error; however, there still can be errors in the diagnosis, and sometimes prolonging diagnosis to test all possibilities results in a worsening of the patient's condition. Also, even once a diagnosis is made, the path of treatment is not always clear-cut.

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  4. "Differential diagnosis" is a practice common among of doctors of recording multiple possible diagnoses of a condition. This allows for the inexact nature of medicine, including the variability of patients and doctoral judgement. The benefit of this strategy is that the doctor, rather than zeroing in on a single diagnosis at the outset, always has multiple options in mind while examining the patient and running tests. A benefit for the doctor and drawback for the patient is that a "differential diagnosis" lowers the doctor's culpability. Since most doctors proceed when they are fairly certain, rather than completely positive, the potential drawback of indecisiveness doesn't play a role in Nolen's book. But if two possible diagnoses have very different treatments and a doctor is unable to come to a conclusion, then there could be trouble.

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  5. Doctors use "differential diagnosis" to narrow down a patients possible problem. Because it is nearly impossible for a doctor see a patient and automatically know what is wrong, doctors take into account the patient's medical history, gender, race, age, ailments and other variables to speculate different possible diagnoses. Doctors like House might have the patient under go different tests to determine the exact problem. Dr. Nolen on the other hand, will occasionally err on the side of uncertainty and go straight into surgery to operate on the most probable problem. In many cases this is a good call and eliminates the ailment early on. Other times it can lead to problems. Surgeries can backfire, and patients can die. Overall, Differential Diagnosis allows the doctor a wider range of speculative diagnoses that he can hopefully narrow down to find the true problem.

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  6. “Differential diagnosis” is what doctors use to diagnose patients. The book says that “no two patients are alike, no two doctors are alike, and no two instances of a disease are alike.” It also says that all parts of medicine are “inexact” which means that nobody knows for sure if a diagnosis is correct until procedures are carried out to try to fix it. For example, the book provides the example about how some doctors think patients have appendicitis, but realize that it wasn’t the problem after they operate. About 15 percent of the time, the doctors are wrong when they diagnose patients with appendicitis. However, there are such limited resources, doctors, and time that doctors sometimes don’t have the option of carefully studying a patient before making a diagnosis. Sometimes patients benefit if the diagnosis is correct which is seems to be a lot of the time. However, if patients receive the wrong diagnosis, it may end their lives.

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  7. "Differential diagnosis" refers to the way in which doctors diagnose their patients' conditions when they diagnosis them for multiple things. Because there are so many variables that could determine what the patient's symptoms mean, "differential diagnosis" is used to account for all of them. It's beneficial if the one diagnosis that would have been chosen was wrong. By running tests on the different possibilities of diagnosis, it reduces the chance of error. On the other hand, diagnosing for many things may slow down the process of recovery, because the doctors will take longer to decide what surgery or medicine to give.

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  8. As Dr. Nolen acknowledges, there are "too many variables" in medicine, which is why it "isn't an exact science." Because of medicine's indefinite nature, doctors use the "differential diagnosis," in which they come up with a variety of different diagnoses for any given ailment. It's nearly impossible for a doctor to be certain about a patient's illness, because there are simply too many factors at play. If tests are made and the results show that the doctor's initial diagnosis was incorrect, the doctor can proceed down the list of diagnoses until he encounter one that fits. However, making the proper diagnosis is merely the beginning for the doctor: he must then decide which treatments to follow. As Nolen writes, "every step of the way you have to choose between options." If the doctor's decisions are well made, then "differential diagnosis" will be successful; if not, then the patient may find himself in grave danger.

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  9. Differential diagnosis is the method that Dr. Nolen and his fellow doctors use when a patient comes in with any problem. In differential diagnosis, a list of possible diagnoses are written down, with the most common/probable diagnosis noted at the top. For example, if a patient came in complaining of a sharp pain in his right side, the doctor would list many possible diagnoses. The most likely diagnosis is appendicitis, but other diagnoses would be listed as well. The benefit of this practice is that no diagnosis is taken for granted. Doctors understand that the best diagnosis might not be the most obvious one and so this process makes doctors less likely to wrongly diagnose because they will be much more aware of the many possiblities. The drawback is that doctors may want to run many more tests in order to eliminate fully the other possibilities and so this makes the whole diagnosis process take longer. Overall I think that differential diagnosis is definitely a good thing though.

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  10. In the book, Dr. Nolen speaks about the uncertainty and inexactness of medicine and thus the speculation needed in a diagnosis. For a set of symptoms there are a number of different origins and courses of action to treat those symptoms. In addition to the number of diseases, each person is radically different. An example was of appendicitis which was said to be a relatively easy ailment to diagnose, but depending on the person's age, previous diseases,and living conditions, it can look radically different each time. He says that each disease and surgery looks far different from the clear-cut illustrations in a text book. "Differential diagnosis" is writing an extensive list of all possible diseases that could be causing these ailments. By testing for each and every one, the doctor limits variables gradually, making sure they don't treat for an alternate disease. This seems like an entirely good plan, but while surgeons deliberate and hopefully eventually discover the source, the patient can worsen, and sometimes split-second decisions need to be made. All in all, I believe that differential diagnosis is a well-thought out plan.

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  11. When a doctor makes a differential diagnosis, she indicates both the most likely cause of a symptom and a few alternative possibilites. For example, on page 57 Nolen provides an example in which a young woman suffering from chest pains, diarreah, and weight loss is given the diagnosis of appendicitis with a possibility of "regional illitis" (a disease of the small intestine). The practice indicates the potential for error in the primary diagnosis, and in Nolen's time was used even on cases where all the "appropriate" tests supported the main one.
    One advantage of the system is that it prepares doctors for error by forcing them to prepare for a "Plan B". If by some chance one finds the primary diagnosis to be incorrect, and has made a mistake in the operation, she is mentally prepared for an alternative move. While a mistake in an operation could prove fatal, in most cases the differential diagnosis gives the doctor some idea of what to do in an emergency.
    Another advantage is that it dispels the commonly held ideas (as Nolen notes) that doctors are infallible, diagnoses are always correct verbatim, and two people with the same symptoms always have the exact same, finger-pointed disease; overall, it brings medicine in greater touch with reality.
    The only possible disadvantage I can think of is that it could potentially reduce a patient's confidence in her doctor. For, at least for some people, uncertainity, even a trace of it, could bring about fear.

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  12. “Differential diagnosis” is a technique commonly used by doctors in order to deal with the inexact nature of medicine. As Nolen said, no two patients, two doctors or two instances of diseases are alike so many variables come into play when making a diagnosis. With this technique, a doctor will come up with several possible diagnosis after examining a patient to account for any errors that can occur because of the many variables. The doctor can then run the necessary tests to eliminate some the possibilities, choose one diagnosis and then proceed with the proper treatment. This method is beneficial because it reduces the chance of error and a wrong diagnosis. There are some drawbacks, however. For example, in the time in takes to run all of these tests to narrow down the list of possible diseases, the patients condition may worsen. Also, even after running the preliminary tests the doctor may still choose the wrong diagnosis and treatment. Overall the method does seem to have more benefits than drawbacks as it does effectively reduce the possibility for error.

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  13. Differential diagnosis is the process by which the doctor notes multiple possible causes of the patient's illness based on his or her primary symptoms. Factors such as age and side symptoms also play a factor in the diagnostic process. Diagnosing a patient is always nebulous because of the uncertain nature of medicine and human health. Doctors often will amass enough evidence to support their theory, and then prescribe the proper treatments. If the treatments do not work, they move on to the next diagnosis. The benefit of this term is that doctors are not strung up on one single cause of the patient's illness and can be flexible with their diagnoses and treatments. Unfortunately, this may also cause the doctor to run too many unnecessary tests just to obtain patient information for his differential diagnostic process. The patient may be concerned with their guinea pig-like treatment and feel that they are merely a lab where the doctor is recklessly experimenting. Also, doctors may often test for two causes at once and a combination of the two treatments may be harmful.

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  14. After talking to, and examining a patient, a doctor will write down a list of possible conditions that could be causing these symptoms. Of course, if there is a very common sickness that easily fits the demonstrated symptoms, then the doctor will put that on his list right away, but he will also write down other, less probable causes. This way, rare diseases are never discounted. The doctor will then order the proper tests to be administered on the patient and once the doctor has enough data to assume that one of the diseases is probably the cause of the symptoms, he will operate. Of course, doctors do not always diagnose correctly. They could probably be more accurate if, instead of a differential diagnosis, they did extensive tests until they were absolutely sure that they were correct. This, however, would take too much precious time, and the success rate of the differential diagnosis is pretty high.

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  15. The term "differential diagnosis" refers to the process by which doctors account for the many variables of their inexact field. For example, abdominal pain in the lower right side may most likely be appendicitis, but doctors must use differential diagnosis to also consider regional iletis, bowel cancer, pneumonia in order to avoid mistakes.

    The diagnoses of surgeons are wrong about 15% of the time. "With pain in the belly it's appendicitis ten to one the field," but sometimes "the long shot occasionally comes through" (58). The benefit of differential diagnosis is that it's a way to catch the "long shots".

    An example of a drawback is that if a doctor waits to be absolutely certain of the diagnosis, "he would let some of the less certain cases go on to rupture (in the cases of an appendicitis)" (58). It takes valuable time to come up with and test several diagnoses.

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  16. Because of doctors' inability to predict with absolute certainty what the patient's illness is, medicine is generally referred to as an inexact science. To address this issue, doctors like Nolen generally use a "differential diagnosis" process, where doctors list off a couple of different possibilities for the illness, in order of most likely to least likely. This serves as a backup plan for doctors should their first diagnosis be incorrect. Because this process considers many different possibilities, differential diagnosis allows for flexibility in treatment. However, therein lies its problem--because there are so many possibilities, the patients are subjected to more exams than might be necessary.

    Still, I think that differential diagnosis is preferable, and probably even necessary. To wait and be sure of one diagnosis, or to treat for one diagnosis only wastes both the patient and the doctor's time. Since time is crucial especially regarding a critically ill patient, doctors would be best off to do all that they can in order to treat the patient, and not waste time by mulling about.

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  17. Jazmyne
    Differential diagnosis is a process which doctors use to help them correctly diagnose a patient. They come up with many possible diagnoses and after learning more about a patient's symptoms, they can slowly eliminate some of the possible ailments. This process is great because it is sometimes hard for doctors to pinpoint an exact illness for patients, so this helps them keep an open mind about what could be wrong. In this way they can try various treatments and medicines to help the patient.

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  18. "Differential diagnosis" is the method doctors use to diagnose a patient. The doctor will write a series of possible diagnosis in order to make sure that no possibility gets missed. This is done in order to compensate for the inexact nature of medicine. The benefit of differential diagnosis is that doctors will be able to be prepared for all possibility, and patients will have a better chance of being diagnosed correctly, and there almost erase all possibility of a factor falling through the cracks. The drawback is that doctors sacrifice lots of time and money trying to rule out other possibilities, slowing down the treatment process for the patient and making him/her have to pay for all of these extra tests.

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  19. Differential diagnosis is the application of the general understanding of all sciences to medicine. This means that doctor's understand that the symptoms may indicate something,however, the application of symptoms to a specific cause can be wrong due to the inconsistencies and differences withing nature, and by extension human beings and viruses/diseases alike. Doctor's use differential diagnosis to account for nature's differences/inconsistencies. The benefit of differential diagnosis is that if one diagnosis is incorrect a doctor has already a few pre conceived notions as to the possible ailment thus he or she can elaborate further in checking if any given diagnosis is correct. The drawbacks are that a doctor may stay confined or limit themselves because of using differential diagnosis and it may also waste time coming up with/checking a diagnosis when the patients life may be at stake.

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  20. Differential diagnosis is the method used by doctors to try to treat their patient. Because each patient is different, doctors come up with a series of possibilities that the patient might have. If the doctor's first treatment for a possible diagnosis does not work he moves on to using the second treatment and so on. Sometimes even if the doctor is spot on with his diagnosis, the patient can have multiple issues. Thus, differential diagnosis can raise the chances of treating the patient's issue properly. The drawbacks of this method is that ruling out a lot of these possibilities without reaching a conclusion can be expensive and time consuming, which is life threatening. A good example of this can be found in every episode of House.

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  21. Differential diagnosis is a technique used by physicians such as the magnificent Dr. Gregory House to properly diagnose a patient with an unknown affliction. The diagnostician or diagnosticians list the patient’s symptoms and relevant background information such as possible environmental factors and his previous medical history. The doctor then lists all (reasonably) possible causes of said symptoms, and ranks them in order of possibility—sometimes weighted by the risk or severity of treatment for each disease—then begins to treat for them, one at a time, until the treatment works. The main benefit of this strategy is that it allows treatment to begin before the doctor knows for sure what the disease is, which can save rapidly deteriorating patients. However, this is also the main drawback, as it can lead to unnecessary and dangerous treatment like extraneous chemotherapy or surgery.

    The differential method of diagnosis contrasts and can be combined with numerous other methods, such as exhaustive identification, in which all possible, even remotely relevant data is collected in hope of leaving only one diagnostic possibility; the algorithmic method, in which the clinician follows a pre-planned strategy (such as physical exam then blood test then MRI) in all cases; and experiential pattern-recognition, in which the doctor makes a decision based off previous experience with similar cases. An example of the last is determining immediately that a patient does not have lupus… because it’s never lupus.

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  22. The term differential diagnosis refers to the practice of accounting for all possibilities in diagnosing a patient. Doctors who practice differential diagnosis write down and prepare for every diagnosis possible, not just the most likely one. Dr. Nolan notes that medicine is a very inexact science; many different variables, like the age of the patient or the acuteness of pain for example, exist so that no two situations are alike. For this reason, it is beneficial for doctors to use differential diagnosis because it helps a doctor be prepared for any situation. This procedure is beneficial because it reduces the likelihood of errors made by doctors who do not plan ahead for an unexpected occurrence.

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  23. Differential diagnosis is a process by which doctors attempt to accurately identify the root cause of a patient's symptoms. This technique of diagnosis is somewhat of a winnowing process, as the doctor eliminates irrelevant diagnoses, while keeping a few in mind when further examining the patient, so as to take into account the inexact nature of medicine. Through extensive testing, such as MRIs and other imaging examinations, the doctor can continue to narrow down the potential diagnoses.

    This is beneficial because it forces the doctor to keep options open and not eliminate a crucial piece of information, which thereby increases the chance of a proper diagnosis despite scientific uncertainty. This process is also beneficial in a broader sense--it catalyzes the development of more efficient and comprehensive testing methods, such as barium swallows. Barium swallows and other methods of nuclear radiology testing can image a patient's entire gastrointestinal tract, so if a patient is complaining of intestinal pain, the doctor can see in one exam if there is a tumor, ulcer, or one (or more) of a plethora of other medical problems. The same can be said for the development of blood and urine testing technologies.

    Potential drawbacks of this strategy should not be overlooked. Though differential diagnoses decrease likelihood of error, there is still a significant margin (~15%)of error. This can lead to incorrect treatment that at its worst, can kill a patient by aggravating their condition, or at best, be very expensive and overall ineffective. It is also time-consuming in a field where, for many, time is not at all a luxury.

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  24. 'Differential diagnosis' is a technique, or method that refers to the common practice of recording, seeking out and researching all possible different diagnosis for a single patient. Dr. Nolen point outs that although 9 x out of 10, a common set of symptoms accurately is interpreted as appendicitis, that 1 person out of 10 has a different diagnosis that can also be either explained or partially explained by that same set of symptoms. This is possible because no two patients are ever alike. This common routine is beneficial for patients and doctors alike, although shows like House always make me think a stomachache is actually some sub- saharan African leech that's eating my stomach lining, and is going to repopulate until they conquer my brain. Differential diagnosis: bad for the teenage viewer, good for people who are actually sick.

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  25. Differential diagnosis is when doctors examine a patients symptoms and come up with many possible diagnoses so as not to rule out a potential possibility. In order to figure out which diagnosis is correct, doctors make a list of possibilities, then research each one attempting to pick the best option based on specific characteristics. Using symptoms, age and gender of the patient, physicians will eventually rule out all possibilities narrowing down on one diagnosis. This process is beneficial because it allows for all possibilities in the process of determining the patient's diagnosis. It is a more thorough way to determine a diagnosis than simply going with a first instinct which often turns out to be incorrect. There are no apparent disadvantages to using this method. Though this method does not guarantee certainty, it is more accurate than simply going with a first guess.

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  26. In the medical buisness, often the only tools doctors have to make a diagnosis are a list of visible symptoms, and a medical history. Any given symptom could be caused by a number of conditions; not all symptoms may be known or presenting; and sometimes not all present symptoms stem from the same condition. As such, a doctor may make the choice to pick a number of potential causes, rather than choosing the cause they believe most fitting to the symptoms. When working with a differential diagnosis, they then attempt to confirm or eliminate various potential causes until they find enough evidence to attempt a true diagnosis and treatment.
    The benefit to using a differential diagnosis is that the diagnosis and treatment proceed in a much more careful and possibly safe manner. A differential diagnosis can also be helpful if multiple doctors are working on the same case; differing opinions are actually encouraged by a differential diagnosis. One drawback to doing a differential diagnosis is that a differential diagnosis takes much longer before a treatment is selected and tested. In situations such as many found in an emergency room, there is simply not the time to give a differential diagnosis; it is likely in the patients best interest for a doctor to quickly give a diagnosis and treat specifically for it. Aditionally, on cases where there is a prevailing, simple diagnosis (such as a common cold), a differential diagnosis would be an unnecessary ordeal.

    -Nate Donato

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  27. Because medicine is often inconsistent doctors use "differencial diagnosis." It is a process in which doctors do not limit a pateint to only one diagnosis but create a list of possible diagnoses. The doctor can then run tests to eliminate some factors on the list. I think that this system has many pros because there is a smaller chance of error. The doctor does not just decide on one disease but considers multiple options. Yet there could be some problems in running tests that could complicate the actual disease. I think this system is way more effective than just choosing one disease and treating it.

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  28. "Differential diagnosis" is a practice common among of doctors because it requires the recording of multiple possibilities when diagnosing a patient. This allows for the inexact nature of medicine to be corrected through a careful process of elimination. the doctor will come up with and array of hypotheses about what the issue is and will eliminate ones until he finds the most likely diagnosis. the benefit of differential diagnosis is that if one diagnosis is incorrect a doctor has already a few pre conceived notions about what the real problem may be and can work quickly to reconstruct a correct diagnosis. the only downfall in this method is that the doctor has a possibility of letting valuable time slip away for the patient while he takes time finding the correct diagnosis. this concern is only minor though, and is outweighed by the fact that approximately 15% of doctors' disgnosis are incorrect, so taking the extra time is no doubt worth it. this process, although not fool proof, has proven to be the best modern medicine has to offer, when it comes to diagnosing patients

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  29. A differential diagnosis is a systematic way of determining unknown variables in medicine. It is essentially the process of elimination. In medicine specifically, differential diagnosis is the process when a given condition is examined in related factors and concurrent phenomena as found by the patient's doctors. Differential diagnosis allows doctors to understand their patient's symptoms more clearly, come to a reasonable conlusion about their patient's disease, eliminate any life-threatening possibilities, or plan for treatment or intervention of the specific disease or problem.
    Pros/Cons: This could be beneficial because docotors cannot eliminate possible causes, however they can move on from a particular disease if they feel comfortable enough with the assumption that it is not a certain disease. Another reason is that it requires doctors to take chances to eliminate or confirm a possible problem with the patient. A possible drawback of differential diagnosis could be that the doctors can never be 100% certain about a particular disease because they cannot know whether the symptoms fit the disease or not because of tests that they perform. Another drawback the the fact that approximately 15% of doctors' diagnosis' are incorrect.

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  30. A "differential diagnosis" is when a doctor, after examining a patient, brainstorms multiple possibilites for what the patient could be suffering from. With all the variables of a patient's situation - environmental factors, medical history, what bacteria/viruses he/she might have come into contact with, etc. - multiple options must be considered.
    Benefits/drawbacks:
    The one major benefit would be the fact that when multiple options are considered, no potential diagnosis would be looked over. However, a drawback to the "differential diagnosis" would be the exhausting of a hospital's resources and a doctor's time. The more options to consider, the more tests to run. Why subject a patient to more poking and prodding than is strictly needed?

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  31. Differential diagnosis is used to deal with the inexact and often unclear nature of medicine. After examination of a patient's symptoms, medical history, environmental factors, etc. the doctor finds multiple possibilities for diseases that could fit the symptoms (instead of only one). Then, the doctor eliminates many of these possibilities through tests until a final diagnosis is made.
    The benefits of this method is that by considering a variety of options, there is a higher likelihood of making the right diagnosis. However, drawbacks include the fact that often the time that the tests (to eliminate diagnoses) take worsens the condition of the patient, and by the time the correct diagnosis is made, it can be too late.

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  32. Miga's response:

    In the inexact field of medicine, a doctor never can be entirely positive of a diagnosis. Many variables could potentially be the cause of a patient's specific ailment, and because every person is different, these factors can vary from basics such as gender and age, to much more complicated aspects, such as environmental factors. To deal with the challenge of covering all possible causes of a problem, doctors use a technique called differential diagnosis. Differential diagnosis is a systematic approach to determining a diagnosis to a problem with many potential solutions. As featured in the show House M.D, doctors using this method will take into consideration all of the possibilities at hand and eliminate each one as they run specific tests.

    The benefit of this technique is that every potential answer is taken into consideration, generally avoiding the dismissal of a potentially important theory. However, differential diagnosis is not particularly beneficial when faced with a situation in which a doctor has to make a quick diagnosis, because it requires a great deal of thinking and time.

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