Picking your nosology

Many diseases that have names don't deserve them. And some that don't have names deserve them. Can you give it to them? Then do not be to eager to deal out diagnoses in judgement. For even the very wise cannot see all ends.

[apologies to JRR Tolkien]


I find it a useful and humbling exercise to think of diseases that don't currently 'exist' (in our awareness) but easily could. Here is a simple three-step process.

1. Think of a pathological process which is well-understood and operates across multiple organ systems.

e.g. transient vascular occlusion resulting in symptoms from downstream ischaemia. Think claudication (leg), angina (heart), TIA (brain).

2. Think of an organ system in which this pathological process could operate but which is not currently recognised.

e.g. thyroid gland.

3. Imagine what symptoms would result from the process in the organ.

e.g. transient attacks of fatigue and depression.




There are more things in heaven and earth, Horatio,

Than are dreamt of in your nosology.

[apologies to Shakespeare]

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