Being a diagnostician is a privilege and it is this individual who holds the great responsibility of rendering a diagnosis. Unfortunately, many neuromusculoskeletal medical professionals fail to understand the difference between a diagnostician and a technician.
Let me explain by first providing you with several definitions of "diagnosis" as provided by the Merriam-Webster dictionary.
As you can see from above, the words identifying, investigation, and analysis form the foundation of these definitions. Secondary to these, but no less important, are the words disease, cause, and problem.
What happens in many clinical practices unfortunately, is the overpowering presence of the technician above the diagnostician.
Undoubtably, these two hats may be worn by the same individual. That is kosher. But what we must remember however, is that our first and foremost priority is to identify the true reason for their presentation.
Because it is more important that we address the cause of their symptoms, rather than treat the symptoms themselves. Be it a joint dysfunction, an incoordinated movement pattern, or central sensitization, finding the key link is not finding something that we think is important, it is finding something that the patient shows is important. You see, what we think is important is quite often clouded by the treatment methods we employ in practice.
We are always learning the newest, most cutting edge methods. But the methods must serve the goals and unfortunately, we often become defined by our methods. The skills, techniques, and methods are not the Grastons, the ARTs, the kinesiology tapes, and the mulligan mobilizations. The true skills are how to identify and how to asess the body.
It is not about our methods, it is about our analysis.
As Gray Cook states in his new book, Movement,
"...the purity of the evaluation process should not be clouded by the treatment options."
We must be thorough in our evaluation process, leaving no stone unturned. Borrowing from Dr. Craig Liebenson, a thorough history will identify our patients' goals and a thorough examination will identify our patients' capacities. It is our objective to ensure that their capacities exceed their goals. Because in rehabilitation,
"we must look for the requisite frequency exercise that accesses the software in order to reboot the computer"