YouTube Video - Accurate and Inaccurate Diagnosis

Here is my video on Common Diagnotic Errors:

A brief overview: Why discuss the diagnostic process? I think that knowing about the diagnostic process can help you have confidence that you and your doctor or therapist have a solid foundation to work on. This discussion is be specifically about diagnosis in outpatient clinics and offices. I found many articles for the most common misdiagnoses in MH with simple Google and Google Scholar searches. Overall, the most frequently cited diagnoses on the 25 or so sites I looked at were: ADHD, Bipolar Disorder, Substance Use, PTSD and Personality Disorders.

I have noticed four common errors made in mental health diagnosis.

  1. A provider gets stuck in a rut. A diagnosis takes on a special meaning for them, or they are “marketed” by advertizing, often from the pharmaceutical industry.
  2. A couple of details don’t fit and get ignored or forgotten. Please see Katherine’s Story “A Correct Diagnosis” in the Personal Stories section on the NAMI website.
  3. The ailment gets broken down into separate problems instead of seen as big picture. In psychiatry, this often happens when the focus is on too many quantitative measure, and not enough focus on development, environment, and identity.
  4. Associated physiologic symptoms are not investigated with physical exam, blood work, or even a check up with a primary care doctor.

How do I try to be accurate in diagnosis?

  1. Use some quantitative measures.
  2. Complete a well-rounded Bio-Psycho-Social assessment.
  3. Make diagnosis an ongoing discussion, so I don’t miss anything the patient is concerned about. That also gives the patient the opportunity to bring up data that may have initially been too difficult to discuss at first, or that they hadn’t initially considered.
  4. Review our results, taking into account that sub-optimal response MAY BE because of an inaccurate diagnosis.
  5. Keep an ongoing, functional formulation. This allows for us to add data and refine the diagnosis, even if treatment is going well.
  6. Take my Continuing Medical Education seriously

Stay safe, keep following precautions with social distancing, handwashing, and droplet precautions. Keep smiling!