An important lesson from Prof TJ Danaraj

Just sharing an educational tidbit via Prof Punna Wong posted originally in Aequanimitas

Today I share with Aequanimitas one of the MOST IMPT lessons I learnt as a medical student from TJD. He taught us that in making any diagnosis, there MUST be 4 components to it.

1. Anatomical Diagnosis – where is the site of the disease?
2. Pathological Diagnosis – what is the underlying pathology?
3. Aetiological Diagnosis – what is the cause?
4. Functional Diagnosis – what is the functional state of the patient now?

A student who answers (like so many of mine now) “Pneumonia sir” will likely get his leg whacked by the tendon hammer! (Sadly, I cannot use this ‘methodology’ in teaching nowadays, for it will definitely lazer the fact into the students brainstem!)

It is NOT just Pneumonia BUT
“Right Lower Lobe Pneumonia, probably Streptococcal, with patient not in Respiratory Failure”


“Congestive Heart Failure from Chronic Rheumatic Heart Disease with Mixed Mitral valve disease and patient in NYHA Class3”


“End stage Renal failure from Chronic Glomerulonephritis with acidosis and massive fluid overload precipitated by sepsis”

I hope medical students learn this well.

Prof Punna Wong


Malaysian physician, haematologist, blogger, web and tech enthusiast

2 Comments on “An important lesson from Prof TJ Danaraj

  1. Unfortunately, nowadays, we would have a 30 minutes argument about the definition of those four components, and at the end, none of them were interested in the beauty of the philosophy behind the thinking ….

  2. Sadly in my field as a radiologist is to encounter doctors who just vaguely guess where the anatomy is and then ask for a scan of that area. What gets me even more upset is when we tell them the pathology and the junior doctor calls me to ask, so what should I do about it???