I read today the article “How a Rheumatologist Thinks” (November 2010), and I want to say that is one of the most interesting articles I’ve read about clinical medicine. My primary specialty is psychiatry, and I also do internal medicine. I get involved in direct care of patients with rheumatic disorders, and rheumatology is very interesting to me. Perhaps rheumatology is the quintessential diagnostic specialty, but psychiatry is a challenge, too, in another way: how I think as psychiatrist could also form an article because psychiatry still has no pathognomonic findings, and diagnosis remains solely in the clinical basis. The diagnostic procedure for diagnosis of psychiatric disorders and comorbidities (neuropsychiatric and nonpsychiatric conditions that must be diagnosed for good treatment) is the process of medical diagnosis as a cognitive process, allied with experience and knowledge. Psychiatric diagnosis remains solely on clinical ground with the advice of protocols, guidelines, and psychometry. This is a challenge still, even considering the development of neurosciences. I consider psychiatry a specialty that integrates medical practice.
Walter Doege, MD
Brazil
