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Old 01-31-2015, 09:00 AM   #1
johndallman
 
Join Date: Oct 2010
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Default [Basic] Skill of the week: Diagnosis

Diagnosis is the IQ/H TL skill of determining what's wrong with a person who is sick or injured, or how a dead person died. It takes physiology modifiers, equipment modifiers, -5 for internal injuries and -5 or worse for rare diseases. It won't necessarily tell you what's wrong, if your society or medical TL don't understand the problem, but it gives clues and rules things out. I suspect, for example, that there's no penalty to deduce "internal injuries" when someone took a blow to the chest and is now coughing up blood, but precisely what they might be is harder. No roll is required for obvious things like open wounds and missing limbs, but good doctors will check for other conditions once the obvious things aren't going to kill the patient swiftly.

Diagnosis is also the skill for realising that someone isn't actually dead, due to Hard to Kill, Metabolism Control or Body Control. It defaults to IQ-6, First Aid-8, Physician -4 or Veterinary-5. Physiology is the only skill that defaults to Diagnosis. The huge default penalty from First Aid is a problem when a first aider needs a Diagnosis roll to realise that something odd is going on, since (absent Talents) he needs to have 8 points in First Aid to have a better Diagnosis default than his IQ-based one. Clearly, a professional emergency responder needs to have some Diagnosis.

Bio-Tech points out that the -5 to Diagnosis for internal injuries also applies to internal diseases with subtle or ambiguous symptoms. It also points out that Diagnosis is useful in medical experiments, that some diseases have bonuses to Diagnosis (e.g., plague), has an explanation of high-tech medical diagnosis and treatment on p123-129, and provides templates for TL8+ medical professionals. Doctors and forensic pathologists have 95-point templates, plus lenses for various specialties, nurses are 65 points and EMTs 90 points. IQ is, of course vital; Healer talent will partially substitute, but doesn't cover all the skills on these templates.

Bio-Tech doesn't cover dentists, who presumably have optional specialisations in Diagnosis, Physician and Surgery, or optometrists, who probably have specialised Diagnosis and a Professional skill. Other optional specialisations in Diagnosis seem plausible, although they might not be a good idea for generalist doctors, since people are so ingenious at finding strange ways to get sick or hurt. Familiarities with, for example, the characteristic diseases of a region, seem perfectly sensible if the GM wants to bother.

The Healer talent from Basic is somewhat expensive at 10 points per level, but seems to work for cinematic-realistic talented medical professionals. Trimming it to a 5 point talent would probably involve taking out Esoteric Medicine, Veterinary, and either Pharmacy or Psychology, which may well be plausible.

Diagnosis appears on all templates for medically-capable characters, and has various rules notes in other books: Action points out its use in dealing with plagues, and diagnosing poisoning (with Poisons skill for identifying a specific poison). High-Tech, Low-Tech and Ultra-Tech provide diagnostic equipment. Magic provides Cure Disease, which requires a Diagnosis roll to avoid the -5 penalty for an unknown disease, but casting Body-Reading first gives +2 to Diagnosis. Martial Arts points out that Diagnosis-2 will discover that someone has been beaten with a blackjack, which is intended not to leave obvious marks. As for most skills, there are examples that include it in PU3: Talents and PU7: Wildcard Skills. Powers has abilities for using Diagnosis at a distance, and for gaining bonuses by looking inside. Psi-Tech has sufficiently advanced technologies to aid Diagnosis, and Psionic Powers lets you do it with Aura Reading. Chinese Elemental Powers provides chi abilities that boost Diagnosis, and Zombies provides cheerful uses of the skill for dealing with zombie plagues.

Why is Diagnosis separate from Physician? I suspect that it partly reflects the sheer time and effort needed for modern medical training, and partly the fact that knowing what's wrong with someone doesn't necessarily let you do anything about it. The Medicine! wildcard skill provides a simple solution.

While I like playing characters with medical skills, I don't remember doing anything especially cool with Diagnosis. It has tended to be a preliminary skill roll to make before the difficult stuff starts, possibly because GMs find it easier to run medical problems when the PC and the player know what's going on.

Has Diagnosis been important in your games?

Last edited by johndallman; 01-31-2015 at 09:05 AM. Reason: Fix typo
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Old 01-31-2015, 09:16 AM   #2
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Default Re: [Basic] Skill of the week: Diagnosis

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Originally Posted by johndallman View Post

Why is Diagnosis separate from Physician? I suspect that it partly reflects the sheer time and effort needed for modern medical training, and partly the fact that knowing what's wrong with someone doesn't necessarily let you do anything about it. The Medicine! wildcard skill provides a simple solution.
I think the separation is about differentiating characters, and adding meat to medical rolls. They are very common, even in mostly combat games.

I was building a set of templates to allow rapid building of characters in con or one-shot settings, and realized a few weird things about medical templates:

first: EVERYONE has diagnosis. the pharmacist, the nurse, even the esoteric medicine guy.

Second: Your general practitioners primary skill is diagnosis. Your Nurses primary skill is physician. Keep this strait and medical characters make a lot more sense.
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Old 01-31-2015, 10:22 AM   #3
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Default Re: [Basic] Skill of the week: Diagnosis

It can be pretty important in a mysteries game, where figuring out what killed somebody is a vital first step.

It's the go to skill for triage like questions - will this person survive the trip if we try to carry him back with us?

It overlaps a lot with Electronics Operation (Medical) - most medical equipment is diagnostic. And for a lot of ultra-tech medicine the diagnosis is the hard part. Once you know exactly what is wrong the treatment is press the right button to dispense the cure, which doesn't take a skill roll.

I've used it in a fantasy setting to determine details of what evil spirit or curse was afflicting somebody.

It would probably be the skill you'd roll against to realize it is physically impossible for a disease, drug or other medical whatsit to do what the plot calls for it to, but making those rolls is usually unfair to the author.
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Old 01-31-2015, 10:48 AM   #4
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Default Re: [Basic] Skill of the week: Diagnosis

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Originally Posted by ericthered View Post
Second: Your general practitioner's primary skill is diagnosis. Your Nurse's primary skill is physician. Keep this straight and medical characters make a lot more sense.
That's certainly true for historical TL7-8. I have the impression that historical TL6 GPs had to do more Physician work, because the local hospital was often further away, and there were fewer nurses working outside hospitals. Nurses also did a fair bit more manual labour which nowadays is done by cheaper auxiliary staff.
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Old 01-31-2015, 10:55 AM   #5
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Default Re: [Basic] Skill of the week: Diagnosis

So far, Diagnosis in my campaigns tends to be used more in low-key House MD moments, i.e. figuring non-obvious ailments and conditions . . . some of which play in the non-medical parts of mysteries.
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Old 01-31-2015, 11:09 AM   #6
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Default Re: [Basic] Skill of the week: Diagnosis

In the real world, there are many conditions that simply cannot be learned before the lab results gets back no matter one's Diagnosis skill.
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Old 01-31-2015, 11:13 AM   #7
Peter Knutsen
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Default Re: [Basic] Skill of the week: Diagnosis

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Originally Posted by johndallman View Post
Why is Diagnosis separate from Physician? I suspect that it partly reflects the sheer time and effort needed for modern medical training, and partly the fact that knowing what's wrong with someone doesn't necessarily let you do anything about it. The Medicine! wildcard skill provides a simple solution.
In terms of inferring what the skills do, based solely on their names, Diagnosis is a lot more obvious than Physician is, especially if one knows the names of the other medical skills that GURPS has (if they weren't there, or if one didn't know they were there, one could well assume that Physician skill covered those things).
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Old 01-31-2015, 11:15 AM   #8
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Default Re: [Basic] Skill of the week: Diagnosis

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Originally Posted by Flyndaran View Post
In the real world, there are many conditions that simply cannot be learned before the lab results gets back no matter one's Diagnosis skill.
I don't mean that kind of thing. I mean externally symptomified but non-obvious things. E.g. a subtle Strabismus. Or that the person in a visored helmet (not seen through from the outside) is positioning her head in such a way that is consistent with not having a functioning right eye.
Or noticing abnormalities in someone's breathing, heart rate, or iris behaviour.
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Old 01-31-2015, 11:38 AM   #9
johndallman
 
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Default Re: [Basic] Skill of the week: Diagnosis

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Originally Posted by Flyndaran View Post
In the real world, there are many conditions that simply cannot be learned before the lab results gets back no matter one's Diagnosis skill.
Perfectly true, for knowing precisely. Without them, one may well know there's something wrong, but not what. But until about the start of TL6, there were no routine lab tests, and since then, some of them - blood sugar is a prominent example IIRC - have been made simple to do without a lab.

I presume actually doing the tests would be Chemistry or Forensics, depending on just what they are. The results tend to be sent back to the doctor who's doing the diagnosis as numbers, rather than a diagnosis of a condition. The doctor who is responsible wants facts, not analysis, which is why lab tests are treated as an equipment modifier to Diagnosis.
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Old 01-31-2015, 12:48 PM   #10
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Default Re: [Basic] Skill of the week: Diagnosis

It's been estimated that 70% (IIRC) of physicians' diagnoses depend on labwork - the techs like to say "without us, your doctor is just guessing."

Of course, some tests can be performed outside a lab (blood glucose is the best-known one, but there are others), and some conditions are obvious enough that they can be diagnosed based on history and presentation, and any labwork performed is merely confirmatory. Injuries rarely need labwork to diagnose, though it may guide treatment.

House, M.D. focuses heavily on diagnosis; although as cinematically unrealistic as any other medical drama, it's a decent illustration of "this is why diagnosis is sometimes hard, and why it's important" for the non-clinician.

It can be used as a prerequisite to medical treatment, but the more interesting use of diagnosis in a game is probably to solve mysteries. Someone who died or behaved strangely may have been affected by a drug, a disease, or a rare medical condition. Alternately, it may give you some indication of a person's activities or lifestyle if they're dead or unresponsive to questioning. You might be able to use it to get clues about someone's state of health, though finding a way to use that information might be more of a challenge...
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