International Journal of Neurooncology

: 2021  |  Volume : 4  |  Issue : 3  |  Page : 130--131

Diagnosis, please?

George C Vilanilam 
 Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. George C Vilanilam
Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala

How to cite this article:
Vilanilam GC. Diagnosis, please?.Int J Neurooncol 2021;4:130-131

How to cite this URL:
Vilanilam GC. Diagnosis, please?. Int J Neurooncol [serial online] 2021 [cited 2022 Jun 26 ];4:130-131
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”Diagnosis, please?” “Diagnosis, please?” came the curt and cold question. It was the practical and viva voce examination for the MD in general medicine that was going on. I stuttered and stumbled trying to give the patient's illness, a suitable name. Just could not fit it all into a single epitaph. Time soon ran out and I successfully convinced the examiners that I was not good enough to become a practicing physician. The symptoms and signs that I picked up so efficiently, did not matter. Only the name, the diagnosis, the syndrome mattered. I just fell short in the final qualifying examination for an M. D. degree in internal medicine. I have to try again 6 months later, perhaps better equipped with epitaphs, names, and syndromes. Physicians and surgeons adore patients with a fancy “diagnosis.” The rarer and exquisite it is, the greater the joy they feel. Taxonomy is inherent to every branch of knowledge. How could human suffering and ailments be any different? Does every tear shed, every ache, and pain need a scientific sobriquet? It does not matter if you cannot cure, just give it all a name.

Susan Singh, a young homemaker, is a very popular face at our hospital. Her incessant hospital visits and admissions have made her very dear to all the people around. For the “undergrads” from the medical school, Susan is a museum of “signs and symptoms.” She has joint pains, heart murmurs, a rare skin rash, subcutaneous nodules and a lot more yet to be discovered. Little wonder that she is often surrounded by medical students and the “exam going” postgrads. A museum of rare physical findings, straight out of the clinical texts, is what our Professors call her. None of our faculty members ever refused to take a bedside “long case presentation” with Susan as the subject. She has been a “long case” for many M. D and MBBS examinations. Susan loves all the attention and hopes that someday she would get better and have to visit the hospital less often. When the medical students fumble with her “diagnosis,” Susan whispers it out and describes her heart murmurs stealthily to them. She takes care to see that her prompting the examinees is not spotted by the examiners. She knows a lot about her illness, perhaps from a different perspective than the budding young physicians who present her case at the clinical meetings. Susan's illness has a name. She has “a diagnosis” and we pride ourselves on having cracked the difficult code. So what, if we cannot cure?

The occasional rare diagnosis thrills the physicians' and surgeons' souls. Kudos and laurels await the doctor who thinks laterally and hits the bull's eye at “the diagnosis,” before anyone else. We thrive on the rare heart murmur, that fancy involuntary movement, the mind-boggling ECG rhythm and that “one in a million” rare syndrome. We capture it on camera, write it up and let the world know about it. Medals and honors are waiting if we can give it all a name–a fancy diagnosis.

This medical epitaph, “the diagnosis” seldom aptly connotes the suffering, the pain, the tears. Vikas Saraswat's tale would illustrate the point. Vikas, an 8-year old schoolboy, has been around for months at our hospital. Despite all our collective encyclopedic wisdom, Vikas' illness hasn't got a name tag yet, I mean, a “diagnosis.” Vikas has been having fever for two long months. He shivers, sweats and the fever wears out after a while, only to be back soon. They prick him every day for the laboratory tests but still have not got a diagnosis. His bone marrow, liver, lymph nodes, and kidneys have all been biopsied, but they have not got anywhere. All the fluids in his system including the cerebrospinal fluid have been sent for analysis but the fever does not seem to get better. He has been put up as an “interesting case” at the clinicopathological conference before a panel of experts, but they still have not found it a name, unraveled the mystery. Despondency has forced them to call it-PUO, pyrexia of unknown origin. A fancy name that suggests that you are still lost and searching. While the search for the elusive “diagnosis” continues, Vikas's fever smolders like a dormant volcano. The stalwarts of clinical medicine and connoisseurs in the “art of diagnosis” rush through Vikas's bed in the morning rounds with a hasty “hi”or “howdya doing”. Perhaps, he reminds them of their fallibilities and failings. No one likes the patient without “a diagnosis.” As for the little boy Vikas, he just wants to be cured. He does not care if his illness has not got a name.

Does pain and suffering need a glorious epitaph? Can you cure the cough, ease the pain or control the seizure, if it doesn't have a name? Diseases need to be named, to understand them better and identify the specialist to treat them. But, does the search for a diagnosis deserve all the brouhaha. Some diagnoses are just so worthy to have, while others are a bane on the afflicted. Many a man's diseases have been cured of symptoms, but the stigma of the diagnosis still lingers on. Every man's suffering due to an illness is different. So why much ado about “the diagnosis?” Diagnose you must, but if you cannot, do not miss out to care and cure [Figure 1].{Figure 1}