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The diagnostic process

A complex task

Steps to diagnosis

Male physician speaking with elderly male patientArriving at a diagnosis is often complex, involving multiple steps:
  • taking an appropriate history of symptoms and collecting relevant data
  • physical examination
  • generating a provisional and differential diagnosis
  • testing (ordering, reviewing, and acting on test results)
  • reaching a final diagnosis
  • consultation (referral to seek clarification if indicated)
  • providing discharge instructions, monitoring, and follow-up
  • documenting these steps and the rationale for decisions made