Can we “suspect” a diagnosis “in advance”?

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Are we missing an important momentum?

Could we make a diagnosis “before” the devastating consequences of a subarachnoid hemorrhage?  Can we make an early  diagnosis of cancer only using the symptoms and signs of a person? The NHS in United Kingdom has established a four weeks period of time after a suspicion of cancer for a definitive diagnosis, but how a doctor can get this “suspicion”? 

We believe that this situation that we call “prediagnosis” can be achieved through a combination of intuition, professionalism, clinical prediction rules, patient engagement, clinical experience  and a proper evaluation of the signs and symptoms of the patient. This concept overlap with others well defined such as “early diagnosis” or ” diagnostic  delay” , two definitions what are defined based on the outcome. Prediagnosis in summary try to put a name to this  period of time where we can act in a prospective way to avoid an important harm to the patient.  In a first approach we could expose the  different components  of this concept to improve the diagnostic process.

 

Dimension Action Outcome
Intuition To be aware. Improve clinical reasoning Increase sensitivity
Professionalism Follow clinical method Better detection
Clinical prediction rules  Define variables with statistical significance Select a population for more testing
Patient engagement Active participation Broad diagnostic possibilities
Signs and symptoms Establish a practical combination of data. Better predictive value

 

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