Introduction to Symptomatology
Introduction to Symptomatology
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 1 from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”
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Chapter 1: Introduction to Symptomatology
Diagnosis is the determination of the nature of a patient’s state of health. It is the sole means by which a doctor can rationally suggest the direction of treatment or referral.
The position of the Council on Chiropractic Education (CCE) is that a doctor of chiropractic, as a member of the healing arts, is a physician concerned with the health needs of the public. He or she gives particular attention to the relationship of the structural and neurologic aspects of the body in health and disease. Serving as a portal of entry to the health-delivery system, the chiropractic physician must be well trained to diagnose, including, but not limited to, spinal analysis; to care for the human body in health and disease; and to consult with, or refer to, other health-care providers.
With respect to diagnosis, the position of the CCE is that appropriate evaluative procedures must be undertaken by the chiropractic physician prior to the initiation of patient care. There must be proper and necessary examination procedures, including recording of patient and family history, presenting complaint, subjective symptoms, objective findings, and skeletal-biomechanical and subluxation evaluation. And, when clinically necessary, such procedures as clinical laboratory tests, instrumentation reports, psychologic evaluation, roentgenographic examinations, and such other procedures should be performed as may be indicated. These findings must be correlated, and a conclusion, a diagnosis, or clinical impressions should be established.
This chapter describes the basic clinical approach used in this manual. The roles of diagnosis and symptomatology in clinical practice are defined. The goals and criteria of case histories and clinical profiles are reviewed. The gross framework for interpreting symptoms and signs is described. An overview of basic chiropractic philosophy is presented. And a simplified approach to differential diagnosis is recommended.
Diagnosis and Symptomatology
The noun diagnosis is derived from the Greek, and it means to distinguish, discern, know, or see through. A diagnosis is any decision, conclusion, or opinion reached by the practitioner. Dorland’s Medical Dictionary defines the word as the determination of the nature of a cause of a disease. Diagnosis implies the identification of a disorder by observation and investigation of its symptoms, signs, and other manifestations. Diagnosis should not be confused with nosology, which refers to the “science” of the classification of diseases.
Within the health sciences, the word diagnosis is used in two separate and distinct ways. First, it is applied to that scientific knowledge which enables one to discriminate between the normal and the abnormal. The purpose of this is to determine the location and nature of disease. Second, it is applied to any conclusion or opinion reached from the examinations conducted. Thus, in the first sense, the doctor uses diagnosis and diagnostic methods in his investigation. In the second sense, the doctor arrives at a diagnosis or clinical opinion concerning the location, nature, and/or cause of the patient’s trouble.
To arrive at a diagnosis is not to arrive at a fixed opinion. The purpose of diagnosis is more than
(1) to identify whenever possible the cause of a patient’s health problem and
(2) to direct therapy towards rehabilitation.
Its purpose is also to assess the effect of therapy. Thus, it is a continuing process: a means to monitor therapy and verify accuracy of the original opinion. Because of this, the first diagnosis arrived at is often referred to as a working or tentative diagnosis in cases not completely clear.
The three major phases of diagnosis are symptomatology, physical diagnosis, and clinical laboratory diagnosis.
Symptomatology relates to symptoms and their significance. Physical diagnosis, obviously, relates to the physical examination of the patient, and clinical laboratory diagnosis refers to the examination of the patient utilizing sophisticated clinical equipment usually requiring technical skills.
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