“Once we realize that imperfect understanding is the human condition, there is no shame in being wrong, only in failing to correct our mistakes” – George Soros
One of the cardinal tenets in medicine is diagnosis before treatment. However, being sure of the existence of a particular disease is not always easy. According to William Osler, “Medicine is a science of uncertainty and an art of probability.” Even then, an orthodox practitioner should not normally treat a patient blindly. This realization has galvanised great research efforts over the centuries to improve the process and means of making diagnosis in order to increase the confidence of physicians when managing patients. The frustration experienced by physicians when treating patients due to inadequate information has therefore lessened over the decades.
This edition of the journal features interesting articles on how we can make better diagnosis when information obtained from the clinical scenarios is non- specific, inadequate or masked. In their review paper, Adewoyin and Nwogoh make a strong case for the use and relevancy of peripheral blood film (PBF) in aiding the diagnosis of several clinical conditions. This is one basic test that the advent of sophisticated machines and molecular studies has not been able to substitute. The authors beautifully brought out the role of trained Laboratory Technologists in carefully preparing slides and the role of physician haematopathologist in the interpretation and reporting of the findings, having taken into consideration the clinical symptoms and signs of the patient.
Patients with somatization disorder actually have a mental/emotional disorder but present with bizarre symptoms that may resemble genuine diseases. Here again, the doctor wants to be accurate in diagnosis; he wants to make sure that what the patient has is a non- organic illness and thereby save time and resources that otherwise could have been expended on unnecessary investigations and wrong treatment. Obimakinde et al surveyed somatization symptoms in 60 cases selected by consecutive sampling of 2668 patients who screened positive for somatising symptoms using validated instruments. Females were commoner than males as expected. The authors identified 5 symptoms of somatization, including crawling sensation and headache. Fifty four percent (54%) of this cohort also had comorbid diseases involving the cardiovascular system.