Diagnosis Vs Formulation

Is diagnosis all there is to a patient? After a correct diagnosis is made, effective treatment can begin. But, what if we've missed something?
Formulation is a holistic way of assessing patients. Both diagnosis and formulation are pertinent in practice, they allow us to investigate aetiology and predict course, and to map out treatment.
This blog article will explain what formulation is, and why it is useful in daily practice. As well as describe the differences between diagnosis and formulation.

What is Diagnosis? 
Diagnosis is the identification of a disease, or pathology that may be causing someone distress, pain or discomfort to a patient. Diagnosis relies on having significant knowledge related to that particular field, and relies heavily on clinical symptoms. A diagnosis is supported by things such as laboratory results, medical imaging, and other diagnostic tests that may be performed. 
Simply diagnosis summaries typical clinical symptoms and signs as well as laboratory results. It assesses what the individual has in comparison to others with the condition. 

What is Formulation? 
Formulation extends beyond diagnosis and is a more holistic way of looking at patients. Formulation treats every patient as unique and different, rather than comparing them to a set of symptoms and signs. It incorporates understanding and personal factors to make a more effective treatment plan. 

Take for instance, a young girl with torn anterior cruciate ligament (ACL). The diagnosis is the torn ACL characterised by physical symptoms of pain and movement dysfunction, and medical imaging showing the tear. But what does this mean to the patient? This is where formulation is an important factor. If we mention that the young girl lives a fit and active lifestyle, and plays competitive netball. From this we can begin to understand that a torn ACL is a seriously debilitating condition for her, and will prevent her from living her usual lifestyle. The importance of effective and timely treatment is paramount in someone like this. Formulation goes above and beyond a mere diagnosis, and allows us to look at the whole picture of a patient. 

Formulation is important because we can gather clues related to our patients. Who are they, what makes them who they are, what do they do, what do they enjoy, what is important for them? And, by understanding this we can provide complete care for them.