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(Not ME/CFS-specific) How does diagnosis go wrong?


Senior Member
I previously highlighted "How psychiatrists think" (cognitive errors they make, etc) - an interesting free paper I thought (see: http://www.forums.aboutmecfs.org/sh...ts-think-quot-(cognitive-errors-they-make-etc) )

I have just read a slightly frustrating piece from the BMJ
When no diagnostic label is applied
Roger Jones,1 Kevin Barraclough,2 Christopher Dowrick3
- frustrating as they are trying to plug the diagnosis, medically unexplained physical symptoms (MUPS).

Anyway, it has the following which I think is interesting:
How does diagnosis go wrong?

Misdiagnosis can occur in two directions. Firstly, the doctor may conclude incorrectly that a patient does not have a condition to which a diagnostic label should be attached, or for which treatment is needed, and hence allow undiagnosed symptoms to persist, such as gastro-oesophageal reflux causing non-cardiac chest pain or chronic cough. Conversely, the doctor may confer a formal diagnosis on the patients symptoms, despite the absence of adequate evidence of a recognisable medical disorder, such as making a diagnosis of vertebrobasilar insufficiency in a patient with vague unsteadiness. A sense of pressure to make a specific diagnosis can come from patients, from fear of litigation if a disease is missed,11 or from the expected role of general practitioners as identifiers of disease.12

Wrong diagnoses in primary care can be caused by atypical and non-specific presentations, very rare conditions, and comorbidity, and also perceptual factors such as failure to observe subtle changes in colour or contour or abnormal swellings13 or gradual changes over time, as sometimes happens with patients with hypothyroidism or acromegaly. Other causes are shown in the box.

Causes of wrong diagnoses in primary care

Cognitive oversightsimply not thinking of the correct diagnosis14for example, forgetting coeliac disease as a cause of iron deficiency anaemia

Failure to gather adequate datafor example, inadequate physical examination for lower bowel symptoms caused by colorectal cancer

Misinterpretation of datafor example, diagnosing gout on the basis of a raised serum urate concentration or excluding it on the basis of normal serum urate.

Anchoringsticking to an initial diagnosis despite disconfirming evidence,15 such as treating fatigue as depression despite evidence of abnormal renal function

Inappropriate confirmationselective use of evidence to confirm an incorrect diagnosis, such as attributing importance to minor abnormalities in laboratory tests as an explanation for fatigue in someone with depression

Premature closurearriving at a conclusive diagnosis before collecting all the data,16 such as diagnosing intermittent (vascular) claudication in a patient with lumbar canal spinal stenosis