Individuals with cancer have multiple symptoms, which frequently co-occur. A nonrandom distribution of symptoms suggests a common mechanism. Symptom clusters (SCs) were considered part of various syndromes in the early years of medicine. The SC concept in clinical medicine is old. Symptom clusters were commonly described in the psychology/psychiatry and neurology literature. Symptom cluster may be defined either clinically or statistically. Statistically derived clusters can differ from clinically defined clusters. The clinical importance of statistically derived clusters is unclear. Pain-insomnia-fatigue and pain-depression-fatigue are commonly recognized clinical clusters. Nausea-vomiting and anxiety-depression are also statistically observed clusters. The longitudinal stability of clusters is unknown. Certain SCs, appear to have a greater adverse influence on outcomes (such as performance status and survival) than others. Comorbidities probably influence symptoms at different levels, but their effect o...

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Clinical observation in hippocrates: an essay on the evolution of the diagnostic art.

Cancer symptom clusters: old concept but new data.

Ten individuals are responsible for the development of modern physical diagnosis: Hippocrates, Vesalius, Morgagni, Sydenham, Auenbrugger, Corvisart, Laennec, Louis, Mueller, and Osler. Their accomplishments form a "golden thread [that runs] throughout the history of the world, consecutive and continuous, the work of the best men in successive ages" (Moxon, quoted by William Osler). The pool of information presented in this book has been created by the scholarship of these ten men. They were physicians going about the daily practice of medicine. The story of their achievements serves to stimulate the spirit of inquiry in each of us and underscores the obligation we have to add to this pool of knowledge. This chapter traces the historical evolution of modern clinical diagnosis. Knowledge of this evolution provides the student with a foundation upon which to build mastery of the art and science of diagnosis.

The Origins of the History and Physical Examination

Pivotal to best-practice medicine in the 21st century is the concept of differential diagnosis. What the classification of disease, nosology, is to pathology, so differential diagnosis is to the management of the individual patient. Doctor-patient interaction comprises a sequence that is a six-link chain comprising history-taking; examination; differential diagnosis; tests and investigations; provisional or definitive diagnosis; and finally, management. This chain, however abridged in detail, determines every medical encounter with every patient. This paradigm has gradually evolved since the time of recorded medical history. It had developed its present form, if not its name, in Western medicine and its derivatives, with the publication of Osler's The Principles and Practice of Medicine, in 1892. The term "differential diagnosis" first appeared in the first edition of Herbert French's book, An Index of Differential Diagnosis of Main Symptoms, published in 1913.

Differentiating diseases: the centrum of differential diagnosis in the evolution of Oslerian medicine.

The chronic fatigue syndrome comprises one of the most challenging issues in contemporary medicine. The condition remains distressing for patients and perplexing to medical science. Clinicians face a management path which has no ''gold standard'' of investiga- tional mileposts; and are locked into a progression where the extremes of either undertreatment or over-investigation may lead to iatrogenic disaster. The themes of investigation, diagnosis and management of patients with the chronic fatigue syndrome remain controversial. This condition joins in historical perspective a series of other diseases such as pink disease, post-traumatic stress disorder (by a variety of names), the Royal Free disease, Q Fever, Ross River disease and chronic ciguatera- all of which have occupied windows of historical time in the twentieth century during which their genesis remained an enigma. In some cases, they still do. New and puzzling diseases will undoubtedly arise in the future. Both patients and medical science are best served if the formal discipline of differential diagnosis is followed unswervingly under these circumstances or ''new'' diseases. The rigour of this discipli- ne-the rank listing of formal possibilities after the clinical history and objective signs have been elicited-forms the pivot of best-practice con- temporary medicine. An example of its power is no more dramatically illustrated by the example of a ''new'' enigmatic disease, chronic ci- guatera, which ''reappeared'' in the 1950s. Ciguatoxins are some of the

Clinical observation in hippocrates: an essay on the evolution of the diagnostic art.

Citations

Cancer symptom clusters: old concept but new data.

The Origins of the History and Physical Examination

Differentiating diseases: the centrum of differential diagnosis in the evolution of Oslerian medicine.

Differential diagnosis: The challenge of chronic fatigue

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