DIAGNOSIS - Medicine for Mountaineering and Other Wilderness Activities - page 2

CHAPTER 1
DIAGNOSIS
James A. Wilkerson, M.D.
Principal Contributor
“Disease manifests itself by abnormal sensations and events (symptoms), and by changes in
structure or function (signs). Symptoms, being subjective, must be described by the patient.
Signs are objective and these the physician discovers by means of physical examination,
laboratory studies, and special methods of investigation.” 1
This statement succinctly describes the way medical disorders are diagnosed. Injuries
resulting from physical forces (trauma) are identified primarily by physical examination.
Symptoms play a greater role in the recognition of nontraumatic disorders. The absence of
laboratories, diagnostic imaging, or other facilities should not prevent attempts at identific-
ation of common disorders in the wilderness. Most disorders have to be at least suspected
before appropriate investigative studies can be ordered.
Diagnosis is usually the most difficult aspect of care for a person with a nontraumatic
disorder. Physicians commonly expend more effort identifying problems than treating them.
In this chapter, outlines help caregivers recognize the organs related to a disorder. Later
chapters contain diagnostic features of the common disorders of specific organs. Caregivers
should consult these sources repeatedly. “Mistakes are just as often caused by lack of thor-
oughness as by lack of knowledge.” 2
Effectively examining someone with a medical disorder is not an easy, straightforward
procedure. A calm, understanding, and sympathetic manner is essential. The ability to ap-
praise the individual's personality and to adopt an approach that instills confidence is vital.
A seriously ill or injured person cannot be expected to be cheerful and understanding or, on
some occasions, even cooperative.
If an individual has traumatic injuries, an initial cursory examination should identify
problems that require immediate attention, such as bleeding, an obstructed airway, or frac-
tures. However, a complete, unhurried, and uninterrupted examination should be carried out
assoonaspossible,althoughevacuation fromapositionofimminent danger,suchasfalling
rock, may be necessary first.
MEDICAL HISTORY
Each individual should be encouraged to describe symptoms in their own words. Leading
questions shouldbeavoided, although some prompting ordirect inquiries are almost always
necessary. Failure to describe a symptom must not be considered a reliable indication that
the symptom is not present.