Dethroning the detective theory of diagnosis

The physician diagnosing disease is often compared with the detective solving a crime. Eight operating principles of fictional detectives are presented and applied to diagnosis in modern medical practice. None holds up under scrutiny. In medicine, every problem does not require a diagnosis and every possibility does not have to be pursued. Time itself may be a diagnostic tool. All the facts may not be available for definitive diagnosis, or a diagnosis may not explain the patient's symptoms. Physicians, unlike fictional detectives, cannot ignore the obvious. They can and should recognize and diagnose diseases they initially failed to suspect.