Medscape: Ignoring Patient Input Tied to Diagnostic Error

Medscape: Ignoring Patient Input Tied to Diagnostic Error

Patients' views are not often included in records of diagnostic errors, but new data released on November 5 suggest that patient and family narratives may contain key information that should formally be included in the system.

 

Will the NHS be able to work out " diagnostic error" from the SNOMED system? Is MUS classified under SNOMED?? Or persistent physical symptoms as Burton wishes to call it.

 

Presumably at present there is no record kept of diagnoses of MUS as a perceived coherent psychiatric syndrome that are subsequently demonstrated to be incorrect, so we have no idea how often such a diagnosis delays the accurate diagnosis of serious and potentially treatable medical conditions.

However, even if the formal misdiagnoses of MUS was recorded this would not indicate how many people's medical symptoms were dismissed or ignored in a culture [that] intentionally disregards and devalues the symptoms presented even if not explicitly labelled as MUS. For example there are a group of conditions associated with pregnancy that are worryingly often missed, possibly more frequently in older mothers, where the mothers' reported symptoms are often ignored/dismissed resulting in preventable miscarriages, but these patients are not likely to be given an MUS misdiagnosis.

The idea of MUS is applied to such a variety of symptoms that in some cases such as ME/CFS it may cause mismanagement, psychological stress and significant deterioration, in others, such as a friend who was refered to psychotherapy for severe chest pain even though she was subsequently found to have a ten inch metal surgical implement left in her chest cavity during heart surgery or the person cited in the above article with metastatic cancer, they are at risk of significant organ damage and death. Why do the advocates of this approach believe there is a common psychiatric process underlying such diverse symptoms?

Is there any evidence that the psychiatric construct of Medically Unexplained Symptoms syndrome that includes people with very diverse medical symptoms ever exists?

The literature often refers to the discomfort of clinicians dealing with this 'group' of patients. Does this whole sorry mess tell us more about the psychological problems of those clinicians and of the psychiatrists/psychologists 'parasitising' these clinicians and their patients than about any real clinical phenomenon?

Is there any profile to the patients so misdiagnosed? Obviously it focuses on conditions that predominantly effect women, also it focuses on conditions that may have a clinically diverse profile such as ME and by default the various autoimmune diseases and such as Lymes that may be misdiagnosed as ME? Is this again suggesting the MUS diagnosis is more to do with the problems of clinicians rather than being a real clinical entity?

 

Yes