Diagnosis du jour


Fam Pract Manag. 2006 Oct;13(9):23-24.

I realize that Dr. Zachary Flake had humorous intent in writing his essay, “Diagnosis Du Jour” [July/August 2006], but it seems to me that a frivolous attitude toward accurate diagnosis is inconsistent with high-quality patient care. Telling worried seniors with ordinary aches and pains that they may have polymyalgia rheumatica will send some of them to the Internet for information. There they can read that this disease can lead to blindness or a stroke, it may be associated with the condition giant cell arteritis that “damages the arteries” and “there is no known cure” (http://www.clevelandclinic.org). The result may be inappropriate anxiety, a needless and unproductive consultation with a rheumatologist and possibly a fruitless course of corticosteroid treatment.

Sloppy diagnosis may “simplify life” for doctors, but it can impede high-quality patient care. A common example of this is diagnosing sinusitis when the real problem is allergic rhinitis. This may lead one to prescribe useless antibiotic treatment and to fail to educate the patient about common-sense allergen avoidance.

I thoroughly enjoyed Dr. Zachary Flake’s article about how a diagnosis can slowly become an epidemic in your practice. I can relate, as I have seen this happen to myself over the years. Recently I’ve noticed how drug companies are taking advantage of this phenomenon. It starts with free CME or a monograph on a new diagnosis. Then maybe an article shows up in a journal. Soon a drug rep wants to discuss the diagnosis and gives me patient handouts or even a patient questionnaire to help me screen for it. Then ads appear during my favorite TV show telling people to go see their doctor if they have the symptoms. The diagnosis seems to take on epidemic proportions; everyone is suffering from it. Finally, a new, expensive drug is released that treats this diagnosis. It’s advertised in journals, newspapers and television. Patients begin calling and requesting it. Since I have been using the diagnosis for several months at this point, everyone already believes they have it and the cure is just a pill away. I begin to feel used, manipulated and even angry – until the next new diagnosis distracts me and the cycle starts again. Please excuse me while I get back to my articles on the prevalence of chronic idiopathic constipation and erectile dysfunction.


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