Wastebasket diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
A trashcan diagnosis or wastebasket diagnosis is a vague or fake medical or psychiatric diagnosis that is given to the patient or to the medical records department for essentially non-medical reasons.[1] It may be given when there's obviously something wrong but the doctor doesn't know what it is, when the doctor wants to reassure an anxious patient about the doctor's belief in their symptoms, when the patient is pressuring the doctor for a label, or when the 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 is somewhat pejorative, in that it 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 a clinical diagnosis.[8]
In the best circumstances, a trashcan diagnosis gives the patient and physician a convenient label for talking about the patient's problems while they are attempting to address the specific issues. In the worst circumstances, the existence of the label results in the patient and physician "treating the label" instead of treating the patient's actual problems.
Specific diagnoses
Many alternative medicine diagnoses, such as candida overgrowth and multiple chemical sensitivities, are considered trashcan diagnoses by medical personnel.
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.[9] Costochondritis, gastroesophageal reflux, and chronic fatigue syndrome are all commonly used as trashcan diagnoses.[9] Bronchitis may be used as a trashcan diagnosis to label sick children.[2] 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.[9]
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 nontypical behavior patterns are labeled as having ASD so that the school can obtain more funding.[citation needed]
Some trashcan diagnoses such as schizophrenia have become more narrowly defined and are now used to refer to specific problems. Others, such as borderline personality disorder, have had a variety of definitions over the years.
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 humours" to neurasthenia to garbled Latin-sounding names which were made up to impress the patient's family.
See also
- Diagnosis of exclusion, the diagnosis given to a patient when all other plausible options have been ruled out
References
- ↑ "trashcan diagnosis". Retrieved 2008-03-29.
- ↑ 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.
- ↑ 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. PMID 1649737.
- ↑ Napodano RJ (1977). "The functional heart murmur: a wastebasket diagnosis". J Fam Pract. 4 (4): 637–9. PMID 853276.
- ↑ GAMBILL EE (1960). "So-called mesenteric adenitis. A clinical entity or wastebasket diagnosis?". Minn Med. 43: 614–6. PMID 13703254.
- ↑ Eastman M (1978). "Senility: the 'diagnostic wastebasket'". Am Pharm. 18 (10): 53. PMID 696591.
- ↑ Freeman HJ (2008). "Refractory celiac disease and sprue-like intestinal disease". World J. Gastroenterol. 14 (6): 828–30. PMID 18240339.
- ↑ Herndon RM (2006). "Multiple sclerosis mimics". Adv Neurol. 98: 161–6. PMID 16400833.
- ↑ 9.0 9.1 9.2 Barron H. Lerner, M.D. (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...