Diagnosis, disease and illness

摘要

In a recent commentary, Pearce trenchantly attacked the dangers of confusing diagnosis with disease. He argued against the use of new syndrome labels such as post-concussional syndrome, post-traumatic stress disorder, repetitive strain injury, and chronic fatigue syndrome, and for the restriction of medical diagnosis to conditions where organic disease processes could be demonstrated. His criticisms must surely evoke sympathy at a time when not a day passes without newspapers, television, radio and lay magazines (even, from time to time, the medical literature) referring to alleged new disorders, often assumed to be due to occupation, trauma or environmental pollution and not infrequently seen as deserving compensation. We agree that it is entirely wrong to assume that every diagnosis implies a documented pathological process, but believe that Pearce's general approach to the diagnosis and management of the patient whose symptoms are unexplained by organic disease is unhelpful and misleading.