Undiagnosed conditions

Most people expect their doctor to determine what's wrong with them at the first or second visit.  Just answer some simple questions maybe get a lab test or two and poof there you have it.

Not exactly.  In many cases it can take months or even years to get a diagnosis.  In some cases you just learn to live with not knowing and wait for science to catch up.  The difficulty between expectation on the part of both physician and patient makes for very strained relationships.  Doctors become surly and outright hostile.  Patient's become stressed and exasperated.  Litigation happens or patients seek services elsewhere.  Doctor's tell patients not to return.  Or imply the medical problems really don't exist.

Some patients recover from being told not to return or being told the doctor doesn't know what's wrong.  Some stop getting any medical care.  Some seek treatment from multiple physicians and then branch out to complementary or alternative treatments, mental health specialists or look to spiritual guidance or psychics.  Some physicians get overly cautious ordering countless tests and procedures.  Some refer out to specialists as soon as it gets ambiguous.  Some move into administrative services and limit direct patient care.

Complaints about medical symptoms which don't resolve within 6 office visits would benefit from treatment by a medical psychologist.  Either the physician or the patient could seek the treatment to help with the medical collaborative process.  A medical psychologist is knowledgeable about medical conditions, diagnostic decision trees, medical research, and how patients talk about symptoms. 

Several years ago I was in a risk management meeting with a major health management organization.  I was seated at a table with a group of physicians which included an internist, cardiologist, orthopedist, psychiatrist, gynecologist, and general practitioner.  We were discussing a case which came to the attention of the company attorneys.  All the identifying information had been stripped out of the case.  We were to discuss work flow, diagnosis and next steps in a step wise manner as the case unfolded.  A female patient presented with neck and back pain after exertion.  She was seen by the physician on-call at the clinic for a same day appointment.  She was seen for 20 minutes.  A full history was not taken.  She was given a prescription for anti-inflammatory medication and told to return if needed.  So I raised the issue of cardiovascular disease with the physician colleagues at the table.  The cardiologist disagreed strongly.  "It's neck and back pain, not chest pain."  "But" I countered "women experience heart problems differently then men, often complaining of neck and back pain with exertion."  I mentioned these findings were noted in medical journals of Cardiology and JAMA, as well as studies from the American Heart Association.   As we went through the documented scenarios of the next four treatment visits for the same problems which were worsening over time, the physicians came to agree that having a single physician in charge of her care would be useful.  Having a full history would be useful.  Up until the last visit where the patient collapsed, the cardiologist and orthopedist were convinced this was not a cardiac event but some problem with her neck or back.  In the final scenario the autopsy proved the woman died of a heart attack and the family sued the physicians involved.  The point was it could all have been avoided with collaborative treatment. 

Over the next several years at the company the physicians who had been at that table for the risk management seminar referred to me anyone they were not able to diagnose after the second meeting for the same symptoms.  Sometimes they just stopped me in the hallway to discuss a case.  These discussions benefited the company, the clinical practices of the physicians, and the patients.  I was able to help people cope with not having a diagnosis.  I was able to help physicians run through branches of medical decision trees or alternative branches, get information and clarify symptom presentation.  Together we saved lives and helped people improve their health. The physicians involved in those discussions didn't limit referrals to psychology to just people with mental symptoms.  The company went on to provide more medical psychology services and to integrate medical psychology into the medical services they provide.  The company remains innovative in treatment and use of psychological services.

If you are a patient or a physician dealing with someone who complains of medical symptoms which are not diagnosed you may want to seek a consultation with a health or medical psychologist.