“What Else Could It Be?” – The Importance of Differential Diagnosis


“What else could it be?” These are five powerful words that you should be ready to ask your doctor during a visit. If you are like most people you probably aren’t looking forward to a visit to see the doctor. As a patient, you don’t have the luxury of always knowing exactly why you are seeing a doctor. All you know is that you have a handful of symptoms which are currently adding up to a decrease in your quality of life. Unfortunately, your doctor doesn’t know why you are seeing him either. He or she must play the role of detective and use all the clues he can find to discover what is ailing you. So here you are in the exam room as your doctor asks you a bunch of questions and examines you to validate your symptoms and discover any others that might present themselves. During this examination, it is your doctor’s job to piece together the information gathered and come up with a diagnosis. This is done through a process called Differential Diagnosis.

Your doctor’s process should be similar to the Sherlock Holmes adage “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” Using clues provided by your descriptions of the symptoms, data from any medical tests you have had, and his medical knowledge your doctor makes a list of all the possibilities. Then using the same information used to make the list he dismisses the items by ruling out those that don’t fit the clues until he or she is left with one diagnosis that fits all of the data.

It would be great if medicine were as simple as that, but it is not. As a patient, we may fail to provide information that would indicate a different diagnosis than the one our doctor gave us. We may respond to treatment in a way that is atypical. We might even have more wrong with us than we know. That’s why a doctor’s diagnosis is always provisional and why being an active participant in this process is important for every patient.

Which brings us back to these five words “What else could it be?” Asking questions is one of the best ways to decrease your risk of a misdiagnosis. It is one of the things that Web MD recommends in their list of “8 Ways to Help Your Doctor Make the Right Diagnosis” Knowing what your doctor thought it might be and why he eliminated it may remind you of a symptom that you failed to mention. It may also be valuable information if you do not respond to treatment like you should. It can even aid another doctor if you decide to get a second opinion before beginning treatment.

Finally, don’t be afraid to get that second opinion especially if the diagnosis and/or treatment raise concerns for you. Doctors are not perfect, they make mistakes just like the rest of us and a second opinion can only be beneficial to you. It will either validate your concern or confirm that your doctor made a good diagnosis. Remember good doctors are not afraid of second opinions, they welcome them.

The Importance of Differential Diagnosis

So next time you are at the doctor don’t forget these five magic words: “What else could it be?”

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