[Health Column] Lee Hak's Diagnostic and Morphological Diagnostic

[Asia Economy] The origin of the word diagnosis is from "dia," meaning through, and "gnosis," meaning knowledge. It refers to inferring the cause of a patient's symptoms through various tests. Depending on the tests performed, diagnosis is divided into physical examination and clinical examination.

Physical examination is a method of obtaining direct information through inspection, palpation, percussion, and auscultation, while clinical examination is a method of obtaining indirect information that cannot be obtained by physical examination alone. In the field of pain, morphological tests such as X-rays and MRI are frequently used among clinical examinations.

Morphological diagnosis is convenient for obtaining images and mainly examines structural abnormalities, which has the advantage of occasionally discovering hidden causes of disease. It also has the advantage of being relatively objective because it is represented in photographs.

On the other hand, physical diagnosis requires careful vigilance because the examination is most important. However, it allows evaluation of function by observing the patient's movements and can detect subtle changes such as color, temperature, wrinkles, and bruises that cannot be seen in photographs through observation. Conversely, it has the disadvantage of being relatively subjective in processing information depending on the examining physician.

In pain treatment, there are patients who question why they are in pain when X-ray results show their bones are fine, and others who refuse treatment saying how can you diagnose supraspinatus tendinitis without even an MRI. These are people trapped in the stereotype of typical morphological diagnosis. Taking a brain scan does not reveal dreams, and taking a heart scan does not show worries. Just as dreams and worries have no form but exist, pain itself has no form but certainly exists. Essentially, trying to confirm the invisible by only looking at what is visible inevitably leads to errors.

What is a correct diagnosis? Naturally, it is a diagnosis that establishes a causal relationship with the patient's symptoms. If symptoms improve with treatment based on the diagnosis, it means the diagnosis is correct. Between physical diagnosis, which obtains direct information, and morphological diagnosis, which examines indirect information, which is more important to make a diagnosis with a high causal relationship? Obviously, physical diagnosis. There are countless physical abnormalities that do not appear in morphological tests. This means diagnosis can be made by physical examination alone. The order of diagnosis also supports this. Physical diagnosis should be made first, and morphological confirmation is used to supplement it; diagnosis should not be made solely based on morphological results without physical diagnosis. To the extent that the American Medical Association recommends reducing MRI use for patients with low back pain.

Times make both doctors and patients busy. Therefore, discussing based on a single image saves time and is convenient. However, one must understand that the price to pay for that convenience can be considerable. If one does not forget the original purpose of treating the painful area, doctors who diagnose by only hanging up images without examining the patient should be avoided. Even if it requires effort, doctors who obtain direct information about the patient can make the correct diagnosis. True affection for patients is shown by the effort to carefully examine them.

Park Yongseok, Director of Haengbok Anesthesia and Pain Medicine Clinic