Diagnosis and nosology in primary care by David Armstrong
Diagnosis in contemporary medicine is made using an underlying
classification system or nosology, the basis of which was first laid
down at the end of the 18th century. The International Classification of
Disease (ICD) was constructed to formalise this nosology, and successive
revisions have attempted to capture technical developments and new
discoveries across the diagnostic landscape. The ICD has proved
particularly applicable in hospital practice where a selected patient
population and access to comprehensive diagnostic aids enable a
pathology-based diagnosis. When it came to be applied to primary care in
the middle of the 20th century, however, it encountered major problems
as general practice struggled to marry a classification of disease to
the rawness of undifferentiated human illness and distress. Eventually, a
classification based on the reason the patient consulted emerged to
replace that based on pathology-defined disease. Analysis of the
frontier zone where a dominant classification system struggles to
maintain order reveals the ways in which medical nosologies, through
their application in the process of diagnosis, attempt to promote and
maintain a certain medical reality.
- PMID: 21669483
- DOI: 10.1016/j.socscimed.2011.05.017