Symptoms, diagnosis, and concepts of disease : Some comments on the semiotics of patient-physician communication

The semiotic processes involved when a person decides he is sick & needs treatment & the types of concepts that can be used in diagnosing disease are explored. The following approaches to disease are discussed: (a) as interference with bodily ,function; (b) as disturbance in soc COMM (eg, in mental illness); (c) as dissatisfaction (with the MD if he does not quick & unambiguous answers); (d) as total collapse (unconsciousness, heart stoppage, etc). Diagnostic processes bear certain resemblances to language processes in general. 'Symptoms & signs' are the perceived facts, & whoever renders a diagnosis interprets these according to disease concepts. The labelling or pattern recognition called diagnosis is not limited to patient-MD interactions, but reflects a general adaptational capacity that preserves health. Symptoms are most easily attributed to the malfunction of part of the body, & this attitude is reinforced by certain soc att's toward disease as well as by the way MD's start their training with dissection. Hurtful external influences, esp when these interfere with maturation of essential neuro-physiological processes, may also bring about disease. End-state diagnosis may reflect the cumulative effects of sequences of pathological stresses & distortions. To the extent that diagnostic thinking leads to the concern that something can be done about the disease, a diagnosis also implies a prognosis. After-effects of diagnosis are esp noticeable when the immediate well-being of the patient, his fam, or the community is in danger. In emergency situations a diagnosis has to be brief & easily understood so that action can be undertaken. Diagnosis can worsen the disease by lowering the patient's self-esteem, thus promoting a feeling of dissatisfaction. Diagnosis may have to be reformulated several times to reflect the patient's changing condition & to take account of any growth or decrement in his language function. Modified Author's Summary.