Diagnosis is a process most often associated with a visit to a primary care physician. However, professionals of many types gather diagnostic information and render diagnoses. Psychiatrists and psychologists predominate in the area of mental health diagnoses, but social workers, educational counselors, substance abuse counselors, criminal justice workers, social service professionals, and those who work with the developmentally disabled also gather mental health diagnostic information and use it in their work.

Over time, the process of assessment has been separated from the actual diagnostic decision, so that assistants and helpers may be the ones gathering and organizing the symptom-related information in order to present it to the expert diagnostician who has the authority to render the diagnosis. This shift has occurred as a matter of financial necessity in many cases, as it is more expensive to use experts for time-intensive information gathering than it is to use such assistants. Increasing effort has also been focused on developing more accurate diagnostic screening and assessment instruments to the same end. If time can be saved on assessment by using screening, so that only very likely cases receive full symptom assessment, then valuable medical resources will be saved. Further, if paper-and-pencil or other diagnostic procedures can be used to better describe symptoms in a standardized manner, then even the time of diagnostic assistants can be saved.

On one hand, such advances may allow more people to be treated in an efficient manner. On the other hand, some complain that people can fall through the cracks and be missed on a screening, and consequently continue to suffer. This situation may be particularly likely for individuals who are not often included in the research upon which the screening instruments are designed, such as women and minorities. Similarly, others suggest that these processes put too much paper between the client and the health care provider, creating barriers and weakening therapeutic relationships.

In considering cultural practices and understandings of the doctor-patient relationship, this effect is even more important, as many cultural groups see the social nature of this relationship as a critical piece of the treatment interaction. While efficiency and saving money are important, it must be recognized that those goals are culturally bound and are choices that are being made. They are not the only way for the art and science of diagnosis to proceed.

It is also important for diagnosticians to recognize cultural differences in terms of the way in which symptoms are experienced, expressed, and understood. For some, mental health disorders may be seen as expressions of underlying spiritual problems; for others, they may be seen as disharmonies among elements in the universe or environment; and for others, they may be seen as extensions of physical problems. Each of these perspectives is a valid way of understanding such conditions, and it is only good training that includes attention to cultural variation in diagnostic procedures and practice that will allow diagnosticians to function effectively.

It should also be noted that culture is not limited to a client's racial background or ethnicity; it also varies by characteristics such as gender, age, sexual orientation, socioeconomic status, and locale. Increasingly, diagnosticians are being forced to grapple with such diversity so as to improve diagnostic procedures and client care. Such characteristics are important to diagnosis not only because of differences in perspectives on illness but also because of differences in the prevalence of illnesses in various groups. This distinction is particularly important when considering medical conditions that might be associated with psychological disorders. In some cases, medical problems may mimic psychiatric disorders; in other cases, they may mask, or cover up, such disorders. Because some disorders are more common in certain populations—such as among women, people of color, and elders—knowledge of such prevalence is important to the process of differential diagnosis.

Culture is also an important consideration in diagnosis because the information gathered is transmitted socially. Knowledge of diagnoses is exchanged among professionals, researchers, clients, and their families. Diagnoses have social meaning and can result in those carrying the diagnosis being stigmatized. As crucial differences exist in the degree of stigmatiza-tion in different cultures, the delivery of such important mental health information deserves thoughtful consideration, good planning, and follow-up to ensure that all parties involved are properly informed.

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