Differential Diagnosis

Overview

What is a differential diagnosis?

When you visit your healthcare provider with symptoms, they will begin a process to diagnose your condition. Since there are a lot of different conditions that often share similar symptoms, your provider will create a differential diagnosis, which is a list of possible conditions that could cause your symptoms. A differential diagnosis is not your official diagnosis, but a step before determining what could cause your symptoms.

What does my healthcare provider’s diagnostic process look like?

There are several steps your healthcare provider will take to make an accurate diagnosis including:

  1. Asking questions about your symptoms.
  2. Reviewing your medical history.
  3. Performing a physical examination.
  4. Creating a differential diagnosis.
  5. Ordering additional tests.
  6. Reviewing test results and symptoms.
  7. Making a diagnosis.

When is a differential diagnosis performed?

A differential diagnosis occurs when your symptoms match more than one condition and additional tests are necessary before making an accurate diagnosis. Tests will narrow down potential conditions on your healthcare provider’s differential diagnosis list.

Test Details

How does a differential diagnosis work?

Your healthcare provider will try to learn as much about your symptoms as they can to make a diagnosis. The process begins during an exam when they'll ask questions related to your condition including:

  • What are your symptoms?
  • How long have you had those symptoms?
  • What is the severity of your symptoms?

Next, your healthcare provider will review your medical history to see if the symptoms connect to any previous health concerns or already diagnosed conditions. Questions about your medical history include:

  • Have you experienced these symptoms before?
  • Have you noticed anything that might trigger your symptoms or make them worse or better?
  • Have you experienced any major changes in your life?
  • What medications, vitamins and/or supplements are you taking?

Last, your healthcare provider will perform a physical examination by checking your blood pressure, heart rate and listening to your lungs.

Your provider will compile a list of potential conditions that relate to your symptoms. To confirm your diagnosis, your provider might offer additional tests to confirm your diagnosis. Tests vary based on your symptoms and could include:

  • Laboratory tests (blood or urine).
  • Imaging tests like an X-ray.
  • Ultrasound.
  • Biopsy.

After your healthcare provider reviews your symptoms, asks questions about your medical history and examines the results of any additional tests, they are able to pinpoint exactly what is causing your symptoms. They'll then make a final diagnosis and recommended treatment.

What can I expect before a diagnostic evaluation?

Before your provider makes a diagnosis, they will evaluate your symptoms by asking questions that go over your overall health and your medical history. It's important to bring a list of any medications, vitamins or supplements that you take with you when you visit your provider’s office so they can keep a record to make sure your medications are not influencing your symptoms.

What can I expect during a diagnostic evaluation?

During a differential diagnosis, it might be daunting to see a list of possible conditions that could cause your symptoms. At this stage in the diagnostic process, your healthcare provider will offer tests as a process of elimination to narrow down your specific diagnosis.

What can I expect after a diagnostic evaluation?

It is important to note that a differential diagnosis is not a complete diagnosis. It is one step that your healthcare provider will take before making a final diagnosis. The process to make an accurate diagnosis, especially with more complex conditions, can take time and doesn’t happen immediately.

Following an evaluation, your healthcare provider might order laboratory or imaging tests to confirm diagnostic theories that will pinpoint which condition is most accurate. After the official diagnosis, your healthcare provider will recommend treatment options.

What are the risks of a differential diagnosis?

A differential diagnosis is part of the diagnostic process that eliminates error. Your healthcare provider’s goal is to treat the correct condition and not endanger you. By forming a differential diagnosis, additional testing is necessary to lead your healthcare provider to the correct diagnosis instead of treating symptoms without understanding the cause. If any step of the diagnostic process is incomplete, there is a risk that the differential diagnosis will lead to an inaccurate diagnosis. With the help of additional testing, the likelihood of error after following the diagnostic process significantly reduces.

Results and Follow-Up

What type of results do you get with a differential diagnosis and what do the results mean?

A differential diagnosis is a list of possible conditions that share the same symptoms that you described to your healthcare provider. This list is not your final diagnosis, but a theory as to what is potentially causing your symptoms. After you receive a list of possible conditions, your healthcare provider will continue their diagnostic process by ordering tests to eliminate potential conditions on your differential diagnosis list. These tests will lead to your diagnosis.

When should I know the results of a differential diagnosis?

Each diagnosis is dependent on the symptoms and complexity of the condition that might be causing them, so there is no set timeline as to when you will know your results. It's important to stay in contact with your healthcare provider during your diagnostic process especially if you have any changes to your symptoms or medical history, which could affect the results of your diagnosis.

When should I call my healthcare provider?

You should contact your healthcare provider if:

  • Your symptoms increase in severity or go away.
  • You acquire new symptoms.
  • You stay in the hospital for any reason.
  • Your current medications change.

Frequently Asked Questions

What are examples of differential diagnoses?

Several conditions share similar symptoms. Your healthcare provider will examine your symptoms before making a diagnosis and offering treatment. If the treatment is not successful, your healthcare provider may offer another diagnosis based on how your symptoms relate to another condition.

The following symptoms and differential diagnoses are examples of what your healthcare provider might consider before making a final diagnosis. Contact your healthcare provider if you experience symptoms to diagnose and treat your condition.

Abdominal pain

Symptoms of abdominal pain include an ache, cramps or sharp pains at mild to severe levels localized to a specific area in your stomach region. A differential diagnosis of abdominal pain includes:

Asthma

Symptoms of asthma include shortness of breath, wheezing, pain or a tight feeling in your chest and coughing. A differential diagnosis of asthma includes:

Back pain

Symptoms of back pain include aching, burning or sharp, stabbing pain that increases when standing, walking, lifting objects or twisting. A differential diagnosis of back pain includes:

Chest pain

Symptoms of chest pain include aching, sharp pain, burning sensations, tightness or squeezing pressure localized in your chest area. A differential diagnosis of chest pain includes:

Cough

Symptoms of a cough include clearing your throat of mucus or fluids and clearing your throat of dry air, irritation or tickle in the back of your throat. A differential diagnosis of cough includes:

Depression

Symptoms of depression include fatigue, low energy, anxiety, showing a range of emotions and appetite changes. A differential diagnosis of depression includes:

Elevated alkaline phosphatase

Symptoms of elevated alkaline phosphatase include stomach or abdominal pain, nausea and vomiting and a yellow color to the skin (jaundice). A differential diagnosis of elevated alkaline phosphatase includes but is not limited to:

Fatigue

Symptoms of fatigue include feeling tired, lack of energy, not getting enough sleep and feeling weak throughout your entire body. A differential diagnosis of fatigue includes but is not limited to:

Headache

Symptoms of a headache include head pain that ranges in severity from mild to severe, a throbbing sensation and sensitivity to lights and sounds with symptoms that last for hours or up to several days. A differential diagnosis of a headache includes:

Hypertension

Symptoms of hypertension include chest pain, headaches, dizziness, shortness of breath and feeling tired. A differential diagnosis of hypertension includes:

Knee pain

Symptoms of knee pain include swelling around the knee, instability when standing, stiffness and popping noises when you move your knee. A differential diagnosis of knee pain includes:

Urinary tract infection (UTI)

Symptoms of a urinary tract infection include feeling like you need to pee even when you have an empty bladder, feeling a burning sensation when you pee and urinating often. A differential diagnosis of a urinary tract infection includes:

A note from Cleveland Clinic

A differential diagnosis is a helpful step in the process that your healthcare provider uses to make a final diagnosis. It may seem overwhelming to see a list of possible conditions that might affect you, but remember that your differential diagnosis is not the final diagnosis. Your healthcare provider will recommend additional tests to confirm your diagnosis and offer treatment to alleviate your symptoms.

Last reviewed by a Cleveland Clinic medical professional on 01/27/2022.

References

  • Canadian Medical Protective Association. Clinical Decision-Making. (https://www.cmpa-acpm.ca/en/education-events/good-practices/physician-patient/clinical-decision-making) Accessed 1/28/2022.
  • Centers for Disease Control and Prevention. Generate a Differential Diagnosis. (https://www.cdc.gov/urdo/differential.html) Accessed 9/16/2021.
  • Cook CE, Décary S. Higher Order Thinking About Differential Diagnosis. (https://doi.org/10.1016/j.bjpt.2019.01.010) Brazilian Journal of Physical Therapy. 2020; 24(1), 1–7. Accessed 9/16/2021.
  • Merck Manual. Multiple pages reviewed for this article. Accessed 9/16/2021.
  • Scott DC, Stern, AS, Cifu DA. Symptom to Diagnosis: An Evidence-Based Guide (https://accessmedicine-mhmedical-com.ccmain.ohionet.org/content.aspx?bookid=2715&sectionid=228237277) , 4e. New York, NY: McGraw Hill; 2020. Accessed 9/16/2021.
  • S. National Library of Medicine. Differential Diagnosis. (https://medlineplus.gov/lab-tests/differential-diagnosis/) Accessed 9/16/2021.

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