Avoiding diagnostic errors in psychosomatic medicine: a case series study (Koyama et al., 2018)

Pyrrhus

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Avoiding diagnostic errors in psychosomatic medicine: a case series study (Koyama et al., 2018)
https://doi.org/10.1186/s13030-018-0122-3

Excerpt:
Koyama et al 2018 said:
Background
Non-organic lesions or diseases of unknown origin are sometimes misdiagnosed as “psychogenic” disorders or “psychosomatic” diseases. For the quality of life and safety of patients, recent attention has focused on diagnostic error. The aim of this study was to clarify the factors that affected misdiagnoses in psychosomatic medicine by examining typical cases and to explore strategies that reduce diagnostic errors.

Case presentation
The study period was from January 2001 to August 2017. The data of patients who had visited the Department of Psychosomatic Medicine, Kindai University Hospital and its branches, Sakai Hospital and Nihonbashi Clinic, were collected. All patients were aged 16 years or over. Multiple factors, such as age, sex, presenting symptoms, initial diagnosis, final diagnosis, sources of re-diagnosis and types of diagnostic errors were retrospectively analyzed from the medical charts of 20 patients. Among them, four typical cases can be described as follows. Case 1; a 79-year-old woman, initially diagnosed with psychogenic vomiting due to depression that was changed to gastric torsion as the final diagnosis. Case 2; a 24-year-old man, diagnosed with an eating disorder that was later changed to esophageal achalasia. Case 10; a 60-year-old woman’s diagnosis changed from conversion disorder to localized muscle atrophy. Case 19; a 68-year-old man, appetite loss from depression due to cancer changed to secondary adrenal insufficiency, isolated ACTH deficiency (IAD).

Conclusion
This study showed that multiple factors related to misdiagnoses were combined and had a mutual influence. However, they can be summarized into two important clinical observations, diagnostic system-related problems and provider issues. Provider issues contain mainly cognitive biases such as Anchoring, Availability, Confirmation bias, Delayed diagnosis, and Representativeness. In order to avoid diagnostic errors, both a diagnostic system approach and the reduction of cognitive biases are needed. Psychosomatic medicine doctors should pay more attention to physical symptoms and systemic examination and can play an important role in accepting a perception of patients based on a good, non prejudicial patient/physician relationship.
 

Pyrrhus

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they looked at some new patients at the psychosomatic medicine dept and eventually almost every one of them had an actual physical impairment, their psychosomatic diagnoses being wrong.

this paper examines some shortcomings in their system, contributing to this problem in diagnosing.

a table in this paper is uses a very formal approach to compare the system used in psychosomatic, wiht the system used in more rigorous medical diagnoses. Could not paste it in here.

from the article, here are how they describe Provider Issues (the problems your doctor is having)

Anchoring is the tendency to be affected by an initial impression that is not adjusted by later information. This was seen in cases 1, 2, and 7.

Availability is the tendency to judge diagnosis by recent experience and the memory of diseases. This was seen in cases 2, 5, 6, 7, 17, 20.

Confirmation bias is the tendency to seek data/evidence to support a diagnosis and to cast away data/evidence that refutes it. This was seen in cases 3, 8, 9, 16, and19.

Delayed diagnosis means that long-term observation is necessary until a true diagnosis is made. This was seen in cases 3, 4, 9, 10, 12, and 20.

Representativeness is the tendency to look for prototypical manifestations of diseases and to miss atypical variants. This was seen in cases 8, 11, and 13–19.
 

seamyb

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Is there actual evidence that psychosomatic illnesses exist? Are there controlled, double-blind studies done that prove they do? Because if not, it's extremely hypocritical for a doctor to fob a patient off when they present ideas around mold or methylation or CCI, or whatever, on the basis that there is insufficient evidence for these things to cause illness, only to be given a diagnosis for which there is no evidence but just so happens to allow the doctor to sleep at night.
 

Pyrrhus

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Is there actual evidence that psychosomatic illnesses exist?
No. None.

The usual way that doctors justify the "existence" of psychosomatic illness is to say:
  1. If a patient has symptoms related to one organ, then it's likely a disease of that one organ.
  2. But if a patient has symptoms related to multiple, unconnected organs, then it's unlikely that the patient simultaneously has diseases of all of those organs at the same time.
  3. Since it's unlikely that a patient would have diseases of all of those organs at the same time, it must not be a real disease.
What this "logic" misses is the fact that all organs in the body are indeed connected - by the nervous system. So, if a patient has symptoms related to multiple, seemingly unconnected organs, then the conclusion should be that perhaps the patient has a disease of the nervous system.
 

seamyb

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No. None.

The usual way that doctors justify the "existence" of psychosomatic illness is to say:
  1. If a patient has symptoms related to one organ, then it's likely a disease of that one organ.
  2. But if a patient has symptoms related to multiple, unconnected organs, then it's unlikely that the patient simultaneously has diseases of all of those organs at the same time.
  3. Since it's unlikely that a patient would have diseases of all of those organs at the same time, it must not be a real disease.
What this "logic" misses is the fact that all organs in the body are indeed connected - by the nervous system. So, if a patient has symptoms related to multiple, seemingly unconnected organs, then the conclusion should be that the patient likely has a disease of the nervous system.
I'd love to see these doctors' faces when they learn about the circulatory system. But this does seem to be the case. My doctor, when I'd protested against his advice to be "reassured", told me he doesn't know of anything that can cause such a multi-systemic set of symptoms. He didn't realise he'd just called himself an arrogant ass. Because he doesn't know something, I should be reassured. If it was real he'd know. Medical science can stop now, for he has been born.
 
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What this "logic" misses is the fact that all organs in the body are indeed connected - by the nervous system. So, if a patient has symptoms related to multiple, seemingly unconnected organs, then the conclusion should be that perhaps the patient has a disease of the nervous system.
this is also a hugely western medicine problem, as the body energetics are ignored. Ignore that at your peril.

A physical injury to my lower back was remedied by working on acupressure points in my feet. 2 weeks. Gone.

Conjunctivitis was cleared, two electrodes on points on the opposite hand- 30 minutes. gone.

meanwhile, my dentist does not believe the body is Hooked together via its various parts. But he gave me a better diagnosis than anybody else ever has. Something allergic going on....he said. (yes, its likely tied to mast cell disorder). The doctor? Just keeps pushing Zoloft.