With the new year come new resolutions and new changes. Starting this year we will begin seeing many changes in how medical diseases are diagnosed. Beginning this month, significant changes are made to the Current Procedural Terminology (CPT) codes that doctors invoke to describe treatment. These codes have expanded from 13,000 to 68,000 different descriptions of medical therapy. In order to best describe treatment, diagnostic descriptions may be altered.
Starting in a few months, the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be issued. (Notice: It will be called DSM-5, not DSM-V. Since doctors no longer study Latin and cannot countenance Roman numerals, we are shifting back to Arabic numbers. Never ask a doctor to decipher which number Super Bowl is approaching!) DSM-5 proposes salient alterations in diagnoses.
Next year, there will be installed a modification of the International Classification of Diseases (ICD-10), which grows more than eight-fold numbering all medical diagnoses, and is inconsistently correlated with the DSM.
These changes will be confounding to practicing physicians. But they also remind us of the imprecision of diagnosis in medicine. Ideally, diagnosis should preface treatment and then cure. The diagnosis of Pneumonia refers to inflammation in the lung. Sixty years ago, this diagnosis could lead to ameliorative ministrations, and sometimes cure, even without modern knowledge. Today, this diagnosis would be incomplete. Doctors need to know the cause of inflammation (infection, tumor, autoimmune response). If, say, the etiology is infection, we need to know what is the offending organism (bacteria, virus, fungus). If, for example, the infection is bacterial, we want to isolate the specific bacteria (pneumococcus, streptococcus, e.coli). And finally, we can grow the organism and determine which antibiotics are most effective against the bacteria. Then the diagnosis of Pneumonia has a greater likelihood of leading to cure.
In psychiatry, diagnoses are not as complete as in some other branches of medicine. We can make a diagnosis of Major Depressive Disorder, evaluate accompanying predominant symptoms (insomnia vs hypersomnia; hyperactivity/anxiety vs low energy; insight vs behavioral characteristics; etc.) and prescribe a psychotherapy approach and medication which might lessen symptoms and, perhaps, be curative. However, since we have not yet isolated a comparable depressococcus germ, our treatment is less specific.
Sometimes, the diagnosis may be wrong, but the treatment, right. A patient who complains of severe “mood swings” may be wrongly labeled Bipolar, even though specific symptoms suggest a different diagnosis, such as Borderline Personality. Treatment with a mood stabilizer and antidepressant may be helpful for the primary symptoms of either disorder.
Although diagnostic labels are valuable in initiating the search for cure, they do not define a human being. We will continue to gather knowledge about disease and refine treatments, but the complexities of each individual must always be paramount in determining how people heal.