Okay, I remember asking about this a long time ago, and apparently this isn't a bug. I think it's kind of ridiculous, though. So my doctor was examining Baako Jang, right? Before I even had my Sim start examining him, there were already a few diagnosis options. When I got through with analyzing his sample, it said that the sample "strongly indicated the presence of an illness." At that point, the only two options were bloaty head and no illness.
Thank goodness I did a few more tests before I assumed that it was bloaty head! After a couple more examinations, I had a guaranteed diagnosis. It was NO ILLNESS, despite the fact that the sample results CLEARLY stated otherwise. Seriously, in this case, I would expect inconclusive sample results, not a "strong indication of an illness," because there WASN'T any illness!
Heck, it would even be nice if it was possible to get an instant guaranteed diagnosis with sample analysis if the patient isn't actually sick. A potential result along the lines of, "this sample shows no indication of any illness," would be great in a situation such as this one.
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In real life medicine there are tests that come back that indicates an illness. Elevated white blood cell count is one of those. So your doctor usually does more workup if your test comes back showing this. There are reasons other than illness that you could have an elevated WBC also. Things like.. medicines you might be taking, stress, allergies, pregnancy.. ect.
Now the sims is not of course like normal medicine it's silly and over the top and not anywhere near as gritty lol. When I have my sim treat another sim I usually keep my camera on the patient, swinging back to observe them often. I watch their symptoms or watch for none during the testing work up. That is pretty much the only way I can narrow down the possibilities other than through testing. Carl's has a good guide on what all the circles, lines, heat, stars, sneezes ect could mean. Sometimes I use that as a cheat sheet if I'm playing a good practitioner. Sometimes I just guess if I want my sim to fail..
If I have any real beef with this system it's the grind. Funny thing is I don't mind the grind in the other careers. Probably because they get out more often early in the career ranks. I usually have to rotate to another house to get a break if I'm wanting a sim to get ahead in the medical career.