Dx Revision Watch
Senior Member (Voting Rights)
https://bjgplife.com/delicate-diagnosis-avoiding-harms-in-difficult-disputed-and-desired-diagnoses/
BJGP LONG READ
‘Delicate diagnosis’: avoiding harms in difficult, disputed, and desired diagnoses
7 October 2022
Margaret McCartney is an Honorary Senior Lecturer at the School of Medicine, University of St Andrews.
Natalie Armstrong is a Professor of Healthcare Improvement Research at the Department of Health Sciences, University of Leicester.
Graham Martin is Director of Research at The Healthcare Improvement Studies Institute, University of Cambridge.
David Nunan is a Senior Research Fellow at the Nuffield Department of Primary Care Health Sciences, University of Oxford.
Owen Richards is Chair of the Patient and Carer Partnership Group, Royal College of General Practitioners.
Frank Sullivan is a Professor of Primary Care Medicine at the School of Medicine, University of St Andrews.
Medical diagnoses can be subject to ambiguity, flux, subjectivity, and inherent uncertainty. This is particularly true in primary care, where many reported symptoms do not conform to a clear diagnosis. Thresholds around normality are often unclear.
Symptoms are commonly experienced and described as an ’iceberg’. Over a third of otherwise well people without a chronic condition have felt tired or run down, or had a headache in the previous 2 weeks, and over a quarter have had back or joint pain.1 Distinguishing conditions that would benefit from diagnosis and earlier intervention from those that are temporary, self-limiting, and prone to harmful medicalisation, remains challenging.
While overdiagnosis is a diagnosis of a condition that, if unrecognised, would not cause symptoms or harm, contested diagnoses are symptoms given a diagnosis, but where the diagnosis, as an explanation for them, is controversial. Opponents consider contested diagnoses ‘wrong’ not because of an error in history taking, clinical examination, or interpretation of a test result (which would risk misdiagnosis), but because the diagnosis itself, for example, chronic Lyme disease or multiple chemical sensitivity, is invalid.2,3 etc.
BJGP LONG READ
‘Delicate diagnosis’: avoiding harms in difficult, disputed, and desired diagnoses
7 October 2022
Margaret McCartney is an Honorary Senior Lecturer at the School of Medicine, University of St Andrews.
Natalie Armstrong is a Professor of Healthcare Improvement Research at the Department of Health Sciences, University of Leicester.
Graham Martin is Director of Research at The Healthcare Improvement Studies Institute, University of Cambridge.
David Nunan is a Senior Research Fellow at the Nuffield Department of Primary Care Health Sciences, University of Oxford.
Owen Richards is Chair of the Patient and Carer Partnership Group, Royal College of General Practitioners.
Frank Sullivan is a Professor of Primary Care Medicine at the School of Medicine, University of St Andrews.
Medical diagnoses can be subject to ambiguity, flux, subjectivity, and inherent uncertainty. This is particularly true in primary care, where many reported symptoms do not conform to a clear diagnosis. Thresholds around normality are often unclear.
Symptoms are commonly experienced and described as an ’iceberg’. Over a third of otherwise well people without a chronic condition have felt tired or run down, or had a headache in the previous 2 weeks, and over a quarter have had back or joint pain.1 Distinguishing conditions that would benefit from diagnosis and earlier intervention from those that are temporary, self-limiting, and prone to harmful medicalisation, remains challenging.
While overdiagnosis is a diagnosis of a condition that, if unrecognised, would not cause symptoms or harm, contested diagnoses are symptoms given a diagnosis, but where the diagnosis, as an explanation for them, is controversial. Opponents consider contested diagnoses ‘wrong’ not because of an error in history taking, clinical examination, or interpretation of a test result (which would risk misdiagnosis), but because the diagnosis itself, for example, chronic Lyme disease or multiple chemical sensitivity, is invalid.2,3 etc.
