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[(ha)13.9(ve)-372(be)19.7(en)-377.7(fo)15.1(rm)19.6(ed)-372(an)13.9(d)-381.2(c)0(o)19.7(u)0(l)14.9(d)-381.2(po)15.1(te)19.6(nt)20.7(ia)19.6(ll)20.6(y)-387(b)0(e)-377.7(c)0(h)19.7(a)0(n)19.7(g)0(e)19.7(d)-387(by)-376.6(th)20.7(e)]TJ
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[(so)15.3(ci)19.5(al)-285.7(fo)20.9(rc)14(es)-285.4(wi)19.8(th)15(in)-284.5(th)20.7(at)-291.5(e)19.8(ld)20.7(.)-297.2(W)0(i)18.4(t)0(h)20.7(i)0(n)-284.5(t)0(h)15(i)0(s)-284.4(a)0(r)19.7(t)0(i)14.8(c)0(l)19.6(e)0(,)-287.9(w)0(e)-286.5(w)0(i)19.8(l)0(l)-290.4(i)0(n)20.7(-)]TJ
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T*
[(un)15.1(de)19.7(rv)20.9(al)19.5(ue)19.7(d)-271.8(n)0(a)19.7(t)0(u)20.7(r)0(e)-262.5(o)0(f)-261.4(c)0(h)19.7(r)0(o)20.9(n)0(i)20.7(c)-273(ed)19.7(em)18.5(a)-273(i)0(n)-261.5(t)0(h)20.7(e)-273(he)19.7(al)19.5(th)-261.5(ca)18.5(re)-262.5(e)19.8(ld)20.7(.)]TJ
/F3 1 Tf
8.9663 0 0 8.9663 59.7543 193.5496 Tm
[(The)-338.2(Problem)-334.2(of)-336.6(Diagnosis)]TJ
/F5 1 Tf
9.843 0 0 9.843 69.7323 177.1086 Tm
[(Diagnosis)-403.5(is)-405.3(a)-399.7(process)-407(whereby)-402.5(disease)-408.4(is)-399.6(distinguished)]TJ
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[(from)-299.3(health,)-300.6(which)-301.4(should)-300.3(then)-299.4(lead)-300.6(to)-301.8(an)-297.1(appropriate)-303.8(treat-)]TJ
T*
(ment.)Tj
7.3823 0 0 6.5614 82.0346 159.5905 Tm
(9)Tj
9.843 0 0 9.843 89.0078 155.2252 Tm
[(Problems)-333.5(may)-334(arise)-330.3(when)-334.7(there)-336.2(is)-330.4(uncertainty)-338.5(about)]TJ
-2.972 -1.1174 TD
[(how)-182.7(to)-186.6(dene)-180.5(symptoms.)-187.2(But)-183(from)-184.1(a)-180.8(sociological)-184.1(perspective,)]TJ
0 -1.1116 TD
[(diagnosis)-206.8(is)-209.5(also)-207.1(a)-203.8(social)-204.8(process)-211.2(in)-203.9(which)-209.3(medicine)-203.9(identies)]TJ
T*
[(what)-357.9(is)-347.7(signicant)-359(in)-347.9(the)-355.9(diagnostic)-353.4(process.)]TJ
7.3823 0 0 6.5614 239.7543 126.7086 Tm
(10)Tj
9.843 0 0 9.843 250.6393 122.3433 Tm
[(In)-353.5(short,)-348.7(di-)]TJ
-19.3929 -1.1174 TD
[(agnosis)-296.6(frames)-297.9(the)-298.3(experience)-299.2(of)-290.2(illness,)-300.3(providing)-292.4(it)-296.2(with)-293.5(a)]TJ
0 -1.1116 TD
[(label)-255.8(and)-246.4(decides)-253(which)-249.6(experiences)-254(of)-249.8(illness)-250.8(are)-253.3(privileged)]TJ
T*
[(and)-413.4(which)-405.1(are)-414.5(silenced.)]TJ
7.3823 0 0 6.5614 157.1527 93.8268 Tm
(11)Tj
9.843 0 0 9.843 168.548 89.4614 Tm
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[(Therefore)-3.9(,)-385.2(dia)-3.9(g)3(nosis)-388.4(i)-2.8(s)-388.4(n)3(ot)-388.7(just)-388.7(a)]TJ
-11.0529 -1.1174 TD
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[(m)-6.7(a)-.9(t)-5.6(t).1(e)-6.7(r)-322.3(o)-5.5(f)-322.3(bi)-5.6(ol)-5.6(og)-5.5(ic)-6.7(al)-328.2(dy)-5.5(sf)-5.5(un)-5.5(ct)-5.6(io)-5.5(n)-322.3(b)-5.5(ut)-322.4(e)-6.7(x).2(i)-5.6(s).4(t)-5.6(s)-322.1(i)-5.6(n)-322.3(a)-323.5(s)-5.3(oc)-6.7(ia)-6.7(l)-322.4(a)-.9(n)-5.5(d)-322.3(po)-5.5(-)]TJ
0 -1.1116 TD
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[(li)5.1(tical)-530.5(con)5.2(t)-.6(ex)5.2(t.)-532.7(F)5.4(u)-.5(r)5.3(t)-.6(h)5.2(e)-1.7(r)5.3(m)-1.7(o)5.2(r)-.5(e,)-532.7(th)5.2(e)-537.3(a)4.1(pp)5.2(li)5.1(cati)5.1(on)-530.4(of)-530.4(a)-537.3(d)5.2(iagn)5.2(os)5.4(is)]TJ
T*
-.017 Tc
[(trans)5.1(f)-.8(o)4.9(r)-.8(ms)-317.4(t)4.8(h)-.8(e)-318.8(i)4.8(nd)4.9(iv)4.9(id)4.9(uals)-311.6(s)-.6(ense)-313(of)-311.8(hi)4.8(ms)5.1(el)4.8(f)-317.6(o)-.8(r)-311.8(h)-.8(erself)-311.8(as)-311.6(they)]TJ
25.5097 67.9242 TD
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[(g)4.5(e)-2.4(n)4.5(e)-2.4(r)4.6(a)-2.4(t)4.4(e)-232.8(a)-232.8(n)-1.2(ew)-232.5(narr)4.6(at)4.4(iv)4.5(e)-232.8(b)-1.2(ased)-231.6(on)-231.6(t)4.4(h)-1.2(i)4.4(s)-231.4(label.)-233.9(Wh)4.6(il)4.4(e)-232.8(s)-1(o)4.5(c)-2.4(io)4.5(lo)4.5(gi)4.4(st)4.4(s)]TJ
0 -1.1174 TD
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0 -1.1116 TD
[(po)-5.4(ra)-6.6(ti)-5.5(n)-5.4(g)-218.5(l)-5.6(a)-6.6(y)-218.5(e)-6.6(xp)-5.4(e)-6.6(r).4(i)-5.5(e)-.8(n)-5.4(c)-.8(e)-6.6(s)-224.1(in)-5.4(to)-224.3(a)-225.4(r)-5.4(el)-5.6(at)-5.5(io)-5.4(na)-6.6(l)-224.4(a)-.8(p)-5.4(p).3(r)-5.4(o)-5.4(a)-.8(c)-6.6(h)-224.3(to)-224.3(ma)-6.6(na)-6.6(gi)-5.6(ng)]TJ
T*
-.0168 Tc
[(i)5(l)-.7(l)5(n)-.6(ess;)-363.6(cl)5(in)5.1(icians)-363.3(focus)-363.3(an)5.1(d)-369.2(a)4(pp)]TJ
12.6829 0 TD
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[(reci)5.2(at)5.2(e)-370.2(t)5.2(he)-364.4(valu)5.3(e)-370.2(o)5.3(f)-369(a)-364.4(pr)5.4(ecis)5.5(e)]TJ
-12.6829 -1.1116 TD
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[(de)-6.5(n)-5.3(it)-5.5(i)-5.4(o).4(n)-5.3(.)-232.3(Th)-5.3(is)-235.5(c)-6.5(a)-.7(n)-235.7(b).4(e)-236.9(s)-5.1(ee)-6.5(n)-229.9(c)-6.5(le)-6.5(ar)-5.3(ly)-235.7(i)-5.4(n)-229.9(a)-236.9(d).4(e)-6.5(b).4(a)-6.5(t).3(e)-236.9(i)-5.4(n)-229.9(t)-5.5(he)]TJ
/F9 1 Tf
20.3145 0 TD
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[(Jo)6.1(ur)6.3(na)6.1(l)-230.1(o)6.1(f)]TJ
-20.3145 -1.1174 TD
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[(Ly)-6.6(mp)-5.4(he)-6.6(de)-6.6(ma)]TJ
/F5 1 Tf
5.1434 0 TD
0 Tc
(.)Tj
7.3823 0 0 6.5614 363.7416 674.7021 Tm
-.0239 Tc
(12)Tj
9.843 0 0 9.843 376.2141 670.3369 Tm
-.0188 Tc
[(T)-3.8(h)3.1(is)-555.4(discussion)-555.5(w)-3.5(a)2(s)-555.4(c)-3.8(once)-3.8(rned)-555.5(to)-555.5(identify)]TJ
-6.6409 -1.1116 TD
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1.0137 -1.1116 TD
0 Tc
[(The)-190(complexity)-193.5(of)-192.2(this)-194.5(discussion)-196.2(is)-192.2(not)-193.5(our)-187.6(concern)-195.5(within)]TJ
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[(this)-327(article,)-331.8(but)-331.7(what)-329.1(these)-330.3(clinicians)-331.6(were)-330.1(concerned)-331.3(about)]TJ
0 -1.1116 TD
[(was)-391(the)-390.5(policy)-393.9(implications)-397.4(of)-388.1(the)-396.2(two)-390.2(terms.)-391.4(While)-395.1(there)]TJ
T*
[(seemed)-293.4(to)-296.1(be)-291.3(a)-296(general)-293.5(preference)-299(for)-291.2(the)-298.3(term)-294.9(chronic)-292.4(ede-)]TJ
0 -1.1174 TD
[(ma,)-313.3(there)-319(was)-316.2(also)-322.3(anxiety)-315.6(that)-316.8(this)-315.5(would)-317.5(be)-314.4(confusing)-322(for)]TJ
0 -1.1116 TD
[(managers)-416.5(provid)-6.7(ing)-412.4(the)-419.3(service)-420(who)-418.9(are)-414.5(familiar)-421.6(with)-420.2(the)]TJ
T*
[(term)-208.5(lymphedema)-218.7(but)-210.8(not)-210.8(chronic)-211.7(edema.)-215.3(Perhaps)-211.2(they)-213(could)]TJ
T*
[(be)-366.2(used)-368.2(synonymously)-371.3(despite)-367.2(the)-373.2(different)-369.5(diagnostic)-370.6(and)]TJ
0 -1.1174 TD
[(treatment)-262.7(regimens)-259.9(associated)-257.4(with)-259(the)-258(different)-260.1(denitions?)]TJ
0 -1.1116 TD
.0128 Tc
[(Would)-287.8(a)-294.7(ch)5.9(ange)-289(in)-293.6(name)-289(affect)-287.9(funding)-287.8(and)-287.8(s).4(ervice)-289(prov)5.9(i-)]TJ
T*
.0125 Tc
[(sion?)-295(The)-300.8(a)-1.3(ut)5.5(hors)-299.4(are)-300.8(c)-1.3(learly)-299.6(concerned)-299.6(h)-.1(ere)-300.8(w)4.8(ith)-299.6(the)-300.8(t)-.2(en-)]TJ
0 -1.1174 TD
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[(sion)-460.7(b)5.8(e)-1.1(tween)-460.7(diagnostic)-461.9(accuracy)-460.7(and)-460.7(t)0(h)5.8(e)-461.9(prole)-461.9(of)-460.7(th)5.8(e)]TJ
0 -1.1116 TD
[(con)5.9(d).2(ition,)-232.5(whi)5.8(c)-1(h)-236(t)5.8(hey)-236(a)4.8(re)-237.1(p)5.9(rofessionally)-230.2(eng)5.9(a)-1(ged)-230.2(w)-.7(ith.)-232.5(T)-1(he)]TJ
T*
[(lan)5.8(guage)-421.5(of)-420.3(d)5.8(i)0(agnosis)-420.2(clearly)-420.4(mat)5.7(ters)-420.2(in)-420.4(relation)-420.4(to)-420.4(bot)5.7(h)]TJ
0 -1.1174 TD
[(treatment)-236.2(a)-1.1(nd)-241.8(the)-237.2(prole)-237.2(of)-241.8(the)-237.2(d).1(isease)-237.2(a)-1.1(nd)-236.1(the)-243(e)-1.1(xi)5.7(stence)-243(o)5.8(f)]TJ
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[(this)-282(deb)5.7(a)-1.2(te)-283.4(clearly)-282.2(illustrates)-282(t)-.1(he)-283.4(ongoing)-282.2(problems)-287.8(i)5.6(n)-288(p)0(r)5.8(o)0(-)]TJ
T*
.0129 Tc
[(vidi)5.9(ng)-281.9(a)-277.3(c)-.9(lear)-276.2(focus)-281.7(in)-276.2(the)-277.3(policy)-276.2(a)-.9(rena.)]TJ
1.0137 -1.1174 TD
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[(The)-387.4(i)-.5(ss)5.6(ue)-393.2(o)5.4(f)-392(di)5.3(agn)5.4(o)-.3(si)5.3(s)-391.8(i)-.5(s)-386(a)-393.2(pr)5.5(ofo)5.4(und)5.4(ly)-386.2(compl)5.3(e)-1.5(x)-392(i)5.3(ssu)5.4(e)]TJ
-1.0137 -1.1116 TD
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[(w)4.4(ith)5.2(in)-357.6(t)5.1(h)-.5(e)-353()-.4(el)5.1(d)-357.6(o)-.5(f)-351.8(c)-1.7(h)5.2(ron)5.2(ic)-358.8(edema)-353(a)-1.7(nd)-351.9(lymph)5.2(e)-1.7(d)5.2(e)-1.7(ma.)-354.2(T)-1.7(h)5.2(e)]TJ
T*
.0231 Tc
[(d)4.7(e)-2.2(bate)-307.5(rag)4.7(e)-2.2(s)-311.9(o)4.7(ver)-312(w)-1.9(h)4.7(e)-2.2(th)4.7(er)-306.3(chr)4.8(oni)4.6(c)-313.2(e)3.6(dema)-313.2(and)-312.1(l)4.6(ymphede-)]TJ
T*
.0236 Tc
[(ma)-203.3(ar)5.3(e)-203.3(p)-.5(u)5.2(r)-.5(el)5.1(y)-202.1(a)-203.3(set)-202.3(o)-.5(f)-202.1(s)5.4(ympto)5.2(m)-1.8(s)-201.9(o)5.2(r)-202.1(w)-1.4(heth)5.2(er)-202.1(th)5.2(ey)-202.1(cons)5.4(tit)5.1(ute)]TJ
0 -1.1174 TD
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[(a)-474.2(n)-.7(ewl)4.9(y)-478.8(emergi)4.9(ng)-473(heal)4.9(th)-473(care)-474.2(pro)5(blem.)-469.6(T)-1.9(hi)4.9(s)-472.8(i)-.9(s)-472.8(d)-.7(eepl)4.9(y)]TJ
0 -1.1116 TD
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[(emb)5.4(e)-1.5(dd)5.4(ed)-328.6(in)-322.9(the)-329.8(n)5.4(ewly)-328.6(emer)5.5(gin)5.4(g)-328.6(ph)5.4(ysi)5.3(o)-.3(lo)5.4(gical)-328.8(d)5.4(ata)-329.8(t)5.3(hat)]TJ
T*
.0233 Tc
[(chal)4.8(len)4.9(g)-.8(es)-288.6(lo)4.9(ng-)5(hel)4.8(d)-288.8(beliefs)-288.6(abo)4.9(u)-.8(t)-288.9(t)4.8(he)-290(f)5(unctio)4.9(n)-288.8(o)-.8(f)-283(t)-1(he)-284.2(ve-)]TJ
0 -1.1174 TD
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[(n)5.7(ous)-449.1(an)5.7(d)-455(l)5.6(ymp)5.7(h)0(atic)-450.5(ci)5.6(rcu)5.7(l)-.2(atio)5.7(n)-455(a)4.6(nd)-449.3(is)-454.9(d)5.7(e)-1.2(eply)-449.3(en)5.7(gag)5.7(i)-.2(n)5.7(g)]TJ
0 -1.1116 TD
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[(acad)5.1(emics)-294.2(i)-.8(n)-300.1(t)-.8(h)5.1(i)-.8(s)-299.9()5.3(eld)5.1(.)-302.5(However,)-296.7(thi)5(s)-299.9(debat)5(e)-301.3(is)-299.9(n)5.1(o)-.6(t)-300.3(i)5(nu)5.1(-)]TJ
T*
[(enci)4.9(ng)-582.5(cli)4.9(n)-.7(i)4.9(c)-1.9(ians)-582.3(who)-582.5(w)-1.6(o)5(r)-.7(k)-582.5(i)-.9(n)-588.2(n)5(on)5(specialis)5.2(t)-588.4(a)3.9(reas)-588(o)5(f)]TJ
0 -1.1174 TD
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[(p)6.5(r).8(ac)5.4(tic)5.4(e.)]TJ
1.0137 -1.1116 TD
0 Tc
[(The)-184.2(heterogeneous)-197.4(nature)-187.6(of)-192.2(the)-188.9(patients)-189.9(affected)-192.1(leads)-192.1(to)-192.4(a)]TJ
-1.0137 -1.1116 TD
[(lack)-225.7(of)-226.8(ownership)-225(of)-226.8(the)-223.5(problem.)-226.7(In)-226.8(some)-225.5(situations,)-228.9(such)-230(as)]TJ
T*
[(following)-327.9(cancer)-328(treatment,)-329.4(lymphedema)-328.1(may)-322.5(be)-325.9(perceived)]TJ
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[(by)-416.9(clinicians)-423.8(as)-423.6(a)-417(minor)-421.5(irritation)-427.5(to)-417(a)-422.7(patient)-419.4(rather)-423.7(than)]TJ
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[(having)-353.5(a)-347.8(profound)-354.3(effect)-355.7(on)-353.5(peoples)-350.9(lives.)-355.8(Clinicians)-354.5(may)]TJ
T*
[(actively)-364(distance)-363.7(themselves)-367(from)-362.7(the)-361.7(implications)-368.6(of)-359.3(their)]TJ
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[(intervention)-442.2(rationalizing)-444.6(that)-437.8(treatment)-447(of)-434.1(the)-442.3(underlying)]TJ
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[(disorder)-280.6(is)-284.4(the)-281.1(only)-281(relevant)-283.2(factor.)]TJ
1.0137 -1.1116 TD
[(The)-478(lack)-484.9(of)-480.2(clarity)-488.4(over)-477.8(the)-482.7(denitions)-484.5(used)-483.4(to)-480.4(dene)]TJ
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[(chronic)-442.1(edema)-448(and)-442.2(lymphedem)-9.1(a)-440(are)-449.1(leading)-442.3(to)-445.8(confusion)]TJ
0 -1.1116 TD
[(over)-310.8(the)-315.6(objectives)-320(of)-313.2(treatment)-320.3(and)-309.7(what)-317.6(constitutes)-319.8(an)-314.4(ef-)]TJ
T*
[(fective)-224.5(outcome.)-222.2(Clinical)-220(outcome)-224.5(measures,)-223.9(such)-224.2(as)-222(volume)]TJ
0 -1.1174 TD
[(change)-217.4(in)-221.2(a)-215.4(limb,)-216.7(have)-219.8(some)-219.7(legitimacy)-223.6(and)-217.6(understanding)-224(in)]TJ
0 -1.1116 TD
[(a)-445.8(specialist)-452.4(lymphedema)-454.8(audience.)-449(There)-452.5(is,)-449.1(however,)-452.1(no)]TJ
T*
[(agreement)-424.8(over)-420.2(the)-419.3(size)-421.4(of)-416.9(volume)-423.8(change)-419(required)-420.1(to)-422.8(be)]TJ
T*
[(effective)-273.9(or)-267.1(a)-267.2(link)-269.6(to)-273(issues,)-269.9(such)-270.3(as)-268.1(health-related)-275.1(quality)-274.2(of)]TJ
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[(life,)-533.4(function,)-532(and)-528.6(cost-effectiveness.)-542.6(The)-529.8(term)-536.8()50.8(volume)]TJ
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T*
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T*
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