1. Clinical Diagnostics Department of gastroenterology Ren-Ji hospital Shanghai Jiao Tong University, School of Medicine Ran Zhi Hua ( 冉志华）

4. Fundamental elements of Diagnostics Diagnosis Identification Analysis

5. Diagnosis （诊断） Derived from Greek words distinguish or discern 识别 / 鉴别 认识 ☆

6. English term Diagnostic The distinguishing sign and symptoms with which it gerenally begins, continues and goes off…as it were, a history of the disease 对疾病特征的识别及对疾病的诊断 In 18th century: Nosography （病情学） 通过疾病的表现来识别疾病内在本质或属性 ☆ ☆

7. In modern usage: Identification of a disease by investigation of its signs and symptoms Medical terminology: Clinical diagnosis Laboratory diagnosis X-ray diagnosis Electrocardiographic diagnosis Gene diagnosis ☆ ☆

8. Identification: ( 识别 ) Inquiry Physical examination Laboratory tests/Special examination Analysis: ( 分析 ) Basic knowledge of medicine Overall analysis Scientific way of clinical thinking

9. Importance of Diagnostics Essential ( 基础） Bridge （桥梁） Tools （工具） Basic courses Clinical medicine

10. Content of Clinical Diagnostics Symptomatic diagnosis ( 症状诊断 ) Physical diagnosis ( 检体诊断 ) Laboratory tests or clinical ancillary tests Medical record Diagnostic processes and the way of clinical thinking

11. Symptomatic Diagnosis History taking （病史采集 )--- Interview ( 问诊） Symptoms ( 症状） --- patient‘s complaints ( 主诉 ) Symptomatic Diagnosis ( 症状诊断 )

12. Symptomatic Diagnosis Subjective sensation that patient describes Fever Cough Rash Mass Physiological & functional Pathological & morphological Symptom （症状）

13. Physical Diagnosis Abnormality observed by the physician Sign （体征） Physical examination （体格检查） Inspection ( 望 ） Palpation （ 触 ） Percussion （ 叩 ） Auscultation （ 听 ） Conducted with thoroughness, alertness to detect even slight derivations from normal

15. Medical record Medical record is a systematized way of storing the required data, information and other relevant documents Specific requirement in terms of format and content

16. Special terms in clinical diagnosis Impression ( 初步印象） Tentative diagnosis （可能性诊断） Differential diagnosis （鉴别诊断） Evidence based medicine （循证医学）

18. Evidence based medicine It is the conscientious （谨慎的） , explicit （明确的） and judicious （有见解的） use of current best evidence in making decisions about the care of the individual patient It means integrating individual clinical expertise （临床专长） with the best available external clinical evidence from systematic research

24. Approaches Basic knowledge learning （基础知识的学习） Clinical practice （临床实践） Bedside activity Standardized patient 床边实践 标准化病人

27. Hippocratic oath

31. Contribution of ancient doctors---Western Laennec RTH 1816

32. Contribution of Western Physician 17th~19th century Leenwenhock Microscopy (end of 17th century) Fahrenheit Thermometer (1724)( 体温计 ) Ludwig Hematomanometer (1847)( 血压计 ) Welcher Hematinometer (1854) ( 血细胞计数仪 ) 20th century X-ray film EKG Endoscopy CT PET

33. Ultrasonic imaging

34. CT imaging

35. MRI

36. PET

37. Traditional Chinese Medicine Wood Fire Earth Metal Water

38. Contribution of ancient doctors---Chinese Inspection Interrogation Smell Pulse palpation 《内经》

39. Pay attention to: Good medical ethics Attach importance to clinical practice Unit theory with practice