"A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible (and the process may be termed differential diagnostic procedure), and may also refer to any of the included candidate alternatives (which may also be termed candidate condition). This method is essentially a process of elimination, or at least, rendering of the probabilities of candidate conditions to negligible levels. In this sense, probabilities are, in fact, imaginative parameters in the mind or hardware of the diagnostician or system, while in reality the target (such as a patient) either has a condition or not with an actual probability of either 0 or 100%."
In this process you examine what symptoms are present and what symptoms aren't. But it is often seen in child abuse cases that these steps are ignored. Often it is simply assumed that child abuse is the answer, when there truly is an underlying condition. In our case there were so many factors missing for them to diagnose abuse. In child abuse you look for bruising, bleeding, burns, cuts, bleeding on the brain, retinal hemorrhaging, subdural hematoma, damage to the internal organs, and damage to bones. When you are looking at a child that has a broken bone, but no bruising, bleeding, burns, cuts, bleeding on the brain, retinal hemorrhaging, subdural hematoma, damage to the internal organs, and even no damage to the tissue surrounding the fracture then according to the process of differential diagnosis, the probability of child abuse being present is greatly reduced, and the likelihood of a metabolic bone issue is greatly increased. If a doctor chooses to ignore these factors then they are essentially violating the Hippocratic oath. What do you think? Shouldn't doctors actually follow a scientific process to come to their solutions rather then making an assumption that can utterly destroy a family? Shouldn't it be more important to be sure of a diagnosis before you testify to it in court? Shouldn't a doctor who has clearly not followed the differential diagnosis process have to answer for his erroneous ways?
In the case of Shaken Baby Syndrome, even the man responsible for creating the diagnosis (Guthkelch) has stated that a differential diagnosis is still not conclusive evidence of shaking.
ReplyDeletehttp://www.npr.org/2011/06/29/137471992/rethinking-shaken-baby-syndrome
In other words, if A, B, and C also cause the same symptoms of SBS, eliminating A, B, and C still does not mean that SBS was the cause. Sadly, often A, B, and C are not eliminated either. X may also cause the symptoms, and we are not yet aware of X. So should we convict someone today and then discover X in 10 years? That was the point that Dr. Guthkelch was making. If you want to prove shaking, then prove it. The triad may be the effects, but it is not the proof. This is where the system has made a serious error in logic.