TY - JOUR
T1 - What diagnosis does not tell
T2 - The case for a noncategorical approach to chronic illness in childhood
AU - Stein, Ruth E.K.
AU - Jessop, Dorothy Jones
N1 - Funding Information:
This researchw ass upportedb y the Departmenot f Health and Human Services.M aternal and Child Health Crippled Children ServicesM. C-R-360402( SocialS ecurityA ct. Title V) Grant and the NIMH funded PreventiveI ntervention ResearchC enter for Child Health (5P50-MH38280).
PY - 1989
Y1 - 1989
N2 - Medical training, practice and research are traditionally organized around body systems and disease categories. There is, however, a disciplinary split over the question of whether the clinical diagnosis is the central issue in describing an individual with an illness. Data from two studies, one institutional and one population based (The Pediatric Ambulatory Care Treatment Study and the National Health Examination Survey-Cycles II and III), are used to test the usefulness of diagnostic groupings in examining correlates of illness. A series of analyses of variance with the diagnostic groupings as the independent variable and a range of psychological, social and educational measures as the dependent variables reveal only the number of significant differences expected by chance. The only area in which a pattern of significant differences is found in the family's interaction with the health care delivery system. These results indicate that there is more variability within diagnostic groupings than between them and suggest that diagnosis is not a helpful categorization in the examination of psychological and social variables. While not surprising to social scientists, these data suggest the need for a major reorientation of the research paradigm when examining the psychological, social, rehabilitative and preventive issues raised by chronic illness in children and families.
AB - Medical training, practice and research are traditionally organized around body systems and disease categories. There is, however, a disciplinary split over the question of whether the clinical diagnosis is the central issue in describing an individual with an illness. Data from two studies, one institutional and one population based (The Pediatric Ambulatory Care Treatment Study and the National Health Examination Survey-Cycles II and III), are used to test the usefulness of diagnostic groupings in examining correlates of illness. A series of analyses of variance with the diagnostic groupings as the independent variable and a range of psychological, social and educational measures as the dependent variables reveal only the number of significant differences expected by chance. The only area in which a pattern of significant differences is found in the family's interaction with the health care delivery system. These results indicate that there is more variability within diagnostic groupings than between them and suggest that diagnosis is not a helpful categorization in the examination of psychological and social variables. While not surprising to social scientists, these data suggest the need for a major reorientation of the research paradigm when examining the psychological, social, rehabilitative and preventive issues raised by chronic illness in children and families.
KW - child health
KW - chronic illness
KW - diagnosis
KW - mental health
KW - noncategorical
UR - http://www.scopus.com/inward/record.url?scp=0024363253&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0024363253&partnerID=8YFLogxK
U2 - 10.1016/0277-9536(89)90157-3
DO - 10.1016/0277-9536(89)90157-3
M3 - Article
C2 - 2772671
AN - SCOPUS:0024363253
SN - 0277-9536
VL - 29
SP - 769
EP - 778
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 6
ER -