Comprehensive diagnosis: a conceptual basis for future diagnostic systems.

Abstract

A discussion of the objectives of diagnosis, participants and architecture leads to the consideration of diagnostic schemas of increasing complexity. Examined first is the conventional case of single-label diagnosis. The case of multiple illness formulation is considered concerning the plurality of mental disorders as well as of general medical disorders. The formulation of a whole clinical condition where contextualized pathology and problems are described is then followed by the consideration of positive aspects of health as well as quality of life. Finally, a comprehensive diagnostic model is reviewed. It integrates a standardized multiaxial formulation (illness, disabilities, contextual factors and quality of life) and an idiographic personalized formulation (culturally informed and contextualized clinical problems, patient's assets pertinent to care, and expectations of health restoration and promotion as jointly understood by clinician, patient and family). Such integrative diagnostic schemas may offer a richer informational basis for clinical description and care as well as a more effective focus for the surveillance of population health.