Diagnostic Ambiguity

For most people a trip to a physician means that a doctor will tell them what is wrong and will tell them how to get better.  For some people it may take a couple of visits or a couple different types of medications.  But for some the diagnosis may take months, years or maybe never.

These people, the ones waiting to be diagnosed, go through an agonizing process which changes how they relate to the medical community, to themselves, to their support system and to information about health care.  In as few as six visits to a physician with no clear diagnosis a couple of things start to happen.  First, the physician is likely to blame the patient for the lack of a diagnosis.  "Maybe you aren't telling me everything."  "Maybe it's psychological."  "Maybe it's stress."  "Maybe you should be seen by a specialist."  Second, the social support system of the patient no longer wants to hear about the illness or the lack of diagnosis.  Third, people will provide information on alternative care techniques which may not help with symptoms and may complicate diagnosis and or treatment.  Over time, patients will avoid medical care and become stuck and focused on information about symptoms.  They will have a phobic, reaction to physicians, diagnoses and treatment attempts.  They will have outright refusal of care and avoidance reactions or become clingy and desperate.  Some will develop specific ideas about what makes them better and worse.  Some of those ideas will have no actual basis in reality.  All of these reactions from the phobic or avoiding, to the clingy, to the superstitious, are all normal variants in dealing with diagnostic ambiguity.  Physicians will become rejecting, hostile, irritated, or overly concerned, intrusive and paternalistic. 

Anyone who has not been diagnosed in 6 to 10 office visits should be appropriately referred to a health psychologist.  What can be expected is specific assistance in managing the symptoms, developing strategies in managing the complex relationship with physicians, significant friends and family and concerned other people, and help in coping with the ambiguity.  A health psychologist can assist with tracking symptom data, setting up symptom recording systems, and looking at all the health care options available including traditional, non-traditional, alternative and complementary, as well as other treatments which may be exploitative for a patient with diagnostic ambiguity.  A health psychologist can provide information to the treating physician on how to provide information to the patient in a manner that best matches how they use medical information.  They can assist the relationship and lessen malpractice risks.