Does diagnosis matter?

Too often the question of diagnosis is split into a binary of “does it or does it not matter”. This creates a dichotomy & polarity between groups. Maybe the concept of granularity is a better perspective than a binary one.

Granularity, in it’s essence, looks at how much detail do we need to go into in a given situation.

 Let’s take back pain. Everyone would agree that obvious signs & symptoms of serious pathology should be investigated with less granularity required for onward referral. Further granularity maybe applied (such as imaging) further down the line by other HCPs.

Most I suspect would also agree that differentiating between more specific Dx’s would also be important & require granularity too. So being granular regarding neurogenic claudication & radicular pain is likely to be of benefit.

This would likely change the prognosis, explanation & treatment around the Dx, therefore giving the level of granularity a benefit for the patient. This might also alter further granulation, e.g. a surgical process.

Next is where the level of granularity might get debatable. For a less clear & specific cause, how much does more granularity benefit the process? For most MSK clinicians the actual ability to become more granular could be regarded as simply guess work.

Added to this, the level of granularity may not change much in terms of treatment or prognosis. Couple this with a level of reliability that is uncertain, & the time spent on becoming more granular might be applied in a better way.

So the granularity of Dx between a disc, or facet or muscle may not be either achievable or matter in the way that a serious or specific pathology might. At this level of granularity we might say “Dx does not matter further”.

This might be role specific though. So a doctor with POCUS & providing injections might feel the level of granularity is warranted & changes outcome significantly. A surgeon would want a greater level of granularity to operate. A radiographer too.

We could apply this to the shoulder too. So do I need to differentiate between a frozen shoulder & a rotator cuff tendionapthy. Yes absolutely, that differentiation changes what happens next in terms of DX & management.

The next layer of granulation could be, do I need to know exactly which tendon? A more debatable level of granulation. Do I need to know the specific part of the tendon? Can we? Again a much more debatable level of granulation.

So rather than a binary debate, we need a more granular one. One that explores the level of detail required given the severity of the problem, If we can be more granular, & if it is likely to affect the actual outcome for the patient.