On botany and gardening - diagnosis and uncertainty in the GP consultation

Diagnosis is not only about disease classification, it also incorporates other ways of knowing. This includes understanding the patient's unique experience of illness, their psychosocial context and any history of trauma.

This article examines how different perspectives on diagnosis can be utilised in the consultation to improve clinical outcomes for patients with chronic and complex illness.

The goal of any clinician is not simply to apply a reliable classification system, but to use scientific knowledge and clinical skill to heal specific patients in their specific contexts. In patients with complex and chronic illness, this involves three types of diagnosis: the medical diagnosis, the psychosocial formulation and the psychiatric diagnosis. These different aspects of diagnosis intersect and interact and involve different ways of thinking about the patient and their illness. Having the flexibility to consider these diverse points of view has the potential to improve our understanding of the patient and their illness and to facilitate healing. Sadler illustrates this diversity of perspectives by using the metaphor of the botanist and the gardener. For the botanist, classification produces a taxonomy that is rigorous and reliable. For the gardener, classification informs the way a garden is developed and nurtured. Both perspectives are important to achieve a good clinical outcome.