J.E. Mezzich : COMPREHENSIVE DIAGNOSIS AS A BASIS

Diagnosis is recognized as the basis for responsible and effective planning of care. In order to fulfill this objective, a number of so termed comprehensive diagnostic models are emerging which deal with diagnosis as both a formulation and a process. As a formulation, comprehensive diagnosis, first, covers a range of domains pertinent to health care, from illnesses to positive aspects of health (e.g., function-ing, strengths, supports, and quality of life). The appraisal and measurement of these domains may be approached through standardized typologies (classical and prototypical), dimensional and confugural scales, and narratives. The evaluators involved include clinicians, the patient, his/her family, and other relevant community members. As a process, comprehensive diagnostic models recognize the importance A the collaborative and dynamic interaction among all participants in the clinical encounter, unfolding longitudinally. Among illustrative comprehensive diagnostic models one can list, first, the WPA International Guidelines for Diagnostic Assessment (IGDA), which include a multiaxial standardized component (1. Illnesses, 11. Funtioning, 111. Contextual Factors, and IV Quality of Life) and an idiographicgraphic personalized component (covering contextualized clinical problems, patient’s positive factors and assets relevant to clinical care and expectations for health restoration and promotion). Another the World Health Organization (WHO) International Family of clasifications, which includes presently as main elements the Interna tional Classification of Diseases and the International Classification of Functioning and Health. Comprehensive diagnostic models, both by furnishing a wide and differentiated informational statement a by stimulating an interactive and longitudinal process among clinicians, patients and their families, can contribute to a systematic articuulation of planning of care (treatment of illness and health promotion) and to the optimization of its outcome.