Wastebasket diagnosis

A wastebasket diagnosis or trashcan diagnosis is a vague diagnosis given to a patient or to medical records department for essentially non-medical reasons.[1] It may be given when the patient has an obvious but unidentifiable medical problem, when a doctor wants to reassure an anxious patient about the doctor's belief in the existence of reported symptoms, when a patient pressures a doctor for a label, or when a doctor wants to facilitate bureaucratic approval of treatment.

The term may also be used pejoratively to describe disputed medical conditions.[2][3][4][5][6] In this sense, the term implies that the condition has not been properly classified. It can carry a connotation that the prognosis of individuals with the condition are more heterogeneous than would be associated with a more precisely defined clinical entry.[7] As diagnostic tools improve, it is possible for these kinds of wastebasket diagnoses to be properly defined and reclassified as clinical diagnoses.[8]

Specific diagnoses

Many alternative medicine diagnoses, such as candida overgrowth and multiple chemical sensitivities, are considered trashcan diagnoses by medical personnel.

Wastebasket diagnoses are often made by medical specialists, and referred back to primary care physicians for long term management. In one study, more than three quarters of primary care visits were found to have no organic or physical cause.[9] It is probable that the stress response and emotional dysregulation contributes to the patient presentation.[10] A list of common wastebasket diagnoses encountered in Family Practice:

- Adult ADD

- Chronic Fatigue Syndrome

- Fibromyalgia

- Subclinical Hypothyroidism

- Seronegative Rheumatoid Arthritis

- Irritable Bowel Syndrome

- Chronic pain syndromes

- Interstitial Cystitis

Diagnoses which include a wide variety of complaints and symptoms are particularly prone to being used as trashcan diagnoses, as well as diseases with variable presentations. For example, fibromyalgia has been used as a trashcan diagnosis to describe chronic pain.[11] Costochondritis, gastroesophageal reflux, and chronic fatigue syndrome are all commonly used as trashcan diagnoses.[11] Bronchitis may be used as a trashcan diagnosis to label sick children.[12] Reactive hypoglycemia has been used as a trashcan diagnosis for people who complain about normal physiological reactions to being hungry. In these cases, the labels are offered when nothing more serious can be identified.[11]

Some diagnoses are being used as trashcan diagnoses in response to unintentional incentives. For example, government-run schools in the United States get additional funding for providing services to students with autism spectrum disorders, so some children with atypical behavior patterns are labeled as having ASD so the school can more easily obtain funding for special education services.[13]

History

Fake diagnoses are not a modern invention. Medicine around the world has a long history of using and abusing the concept of trashcan diagnoses, from "rectifying the humors" to marthambles to neurasthenia to garbled Latin-sounding names which were made up to impress the patient's family.[14][15][16]

Management

The medical community is often split on the best approach to managing a wastebasket diagnosis. The biggest challenge for a physician is maintaining their interest and desire to see the patient through their illness.[17] Anti-depressants and cognitive therapies are commonly employed, speaking to the probable emotional basis that underpins these diagnoses.[18]

See also

References

  1. ↑ "trashcan diagnosis". Retrieved 2008-03-29.
  2. ↑ Smith TL (2003). "Vasomotor rhinitis is not a wastebasket diagnosis". Arch. Otolaryngol. Head Neck Surg. 129 (5): 584–7. doi:10.1001/archotol.129.5.584. PMID 12759275.
  3. ↑ Rauh SM, Schoetz DJ, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1991). "Pouchitis--is it a wastebasket diagnosis?". Dis. Colon Rectum. 34 (8): 685–9. doi:10.1007/BF02050351. PMID 1649737.
  4. ↑ Napodano RJ (1977). "The functional heart murmur: a wastebasket diagnosis". J Fam Pract. 4 (4): 637–9. PMID 853276.
  5. ↑ GAMBILL EE (1960). "So-called mesenteric adenitis. A clinical entity or wastebasket diagnosis?". Minn Med. 43: 614–6. PMID 13703254.
  6. ↑ Eastman M (1978). "Senility: the 'diagnostic wastebasket'". Am Pharm. 18 (10): 53. PMID 696591.
  7. ↑ Freeman HJ (2008). "Refractory celiac disease and sprue-like intestinal disease". World J. Gastroenterol. 14 (6): 828–30. doi:10.3748/wjg.14.828. PMC 2687049Freely accessible. PMID 18240339.
  8. ↑ Herndon RM (2006). "Multiple sclerosis mimics". Adv Neurol. 98: 161–6. PMID 16400833.
  9. ↑ Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989;86:262–6.
  10. ↑ Am Fam Physician. 2000 Feb 15;61(4):1073-1078.
  11. 1 2 3 Barron H. Lerner, MD (25 March 2008). "When the Disease Eludes a Diagnosis". New York Times. Retrieved 2008-03-29. For example, many patients with chest pain carry a diagnosis of costochondritis (inflammation of the chest wall bones) or gastroesophageal reflux (regurgitation of stomach acid into the esophagus). These are real conditions. But they tend to generate little interest from many physicians, who may refer to them as 'wastebasket diagnoses,' offered when nothing more serious has turned up. The frustration of patients who believe that the medical profession takes these types of ailments too lightly has led groups of them to form alliances to publicize their illnesses. Foremost among them are fibromyalgia, a syndrome involving muscular and other pains, and chronic fatigue syndrome...
  12. ↑ Randall G. Fisher; Thomas G. Boyce; Hugh L. Moffet (2005). Moffet's Pediatric Infectious Diseases: A Problem-oriented Approach. Lippincott Williams & Wilkins. pp. 145–. ISBN 978-0-7817-2943-7.
  13. ↑ Stobb, Mike (2007). "Autism 'epidemic' largely fueled by special ed funding, shift in diagnosing". The recent explosion of cases appears to be mostly caused by a surge in special education services for autistic children, and by a corresponding shift in what doctors call autism.
  14. ↑ Thompson, C.J.S. (January 24, 2003) [1928]. Quacks of Old London. Kessinger Publishing. p. 80. ISBN 978-0-7661-3609-0. Retrieved February 11, 2012.
  15. ↑ Grossman, Anne Chotzinoff, Lisa Grossman Thomas, Patrick O'Brian (2000). Lobscouse & Spotted Dog: Which It's a Gastronomic Companion to the Aubrey. pp. 249–250. ISBN 978-0-393-32094-7.
  16. ↑ Burke, Peter; Roy Porter. The Social history of language. pp. 89–90. ISBN 978-0-521-31763-4.
  17. ↑ http://www.nytimes.com/2008/03/25/health/views/25case.html
  18. ↑ http://www.aafp.org/afp/2000/0301/p1423.html
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