Wastebasket diagnosis

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A wastebasket diagnosis or trashcan diagnosis is a vague diagnosis given to a patient or to medical records department for essentially non-medical reasons. 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. It differs from a diagnosis of exclusion in that a wastebasket diagnosis is a diagnostic label of doubtful value, whereas a diagnosis of exclusion is characterized by the diagnosis being arrived at indirectly (through the process of excluding all other plausible causes). Unlike a vague wastebasket diagnosis, the diagnostic label arrived at through a process of exclusion may be precise, accurate, and helpful.

Contents

The term may also be used pejoratively to describe disputed medical conditions. [1] [2] [3] [4] [5] 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. [6] As diagnostic tools improve, it is possible for these kinds of wastebasket diagnoses to be properly defined and reclassified as clinical diagnoses. [7]

Wastebasket diagnoses are often made by medical specialists, and referred back to primary care physicians for long term management.[ citation needed ]

Examples

Common wastebasket diagnoses include:

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. [8] Bronchitis may be used as a trashcan diagnosis to label sick children. [13]

A diagnosis like fibromyalgia is not invariably a wastebasket diagnosis; many "trashcan" labels can be applied specifically and appropriately, and they are considered wastebasket diagnoses only when they are applied to pain or other common symptoms whose origin or cause cannot be determined. [14]

Different specialists provide different wastebasket labels to the same sets of symptoms. [9] For example, in response to a person with chronic pain but no detected medical pathology, a rheumatologist might label the symptoms fibromyalgia, a specialist in physical medicine and rehabilitation might diagnose regional pain, an orthopedic surgeon will call it chronic pain syndrome, and a chiropractor will claim that there is a problem with alignment of vertebrae in the spine. [9] Other specialties similarly focus on their specialty, producing the wastebasket labels from their own fields. [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 atypical behavior patterns are labeled as having ASD so the school can more easily obtain funding for special education services. [15]

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. [16] [17] [18]

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. [19] Antidepressants and cognitive therapies are commonly employed, speaking to the possible emotional basis that underpins these diagnoses or the physician's effort to psychopathologize the patient whose disorder the physician can not identify. [20]

See also

Related Research Articles

<span class="mw-page-title-main">Tietze syndrome</span> Inflammation, tenderness, and pain of the chest wall with swelling present

Tietze syndrome is a benign inflammation of one or more of the costal cartilages. It was first described in 1921 by German surgeon Alexander Tietze and was subsequently named after him. The condition is characterized by tenderness and painful swelling of the anterior (front) chest wall at the costochondral, sternocostal, or sternoclavicular junctions. Tietze syndrome affects the true ribs and has a predilection for the 2nd and 3rd ribs, commonly affecting only a single joint.

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

Fibromyalgia is a medical syndrome which causes chronic widespread pain, accompanied by fatigue, waking unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and a general hypersensitivity. The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors. Environmental factors may include psychological stress, trauma, and certain infections. Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome".

<span class="mw-page-title-main">Chest pain</span> Discomfort or pain in the chest as a medical symptom

Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath. It can be divided into heart-related and non-heart-related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or the elderly may have less clear symptoms.

<span class="mw-page-title-main">Costochondritis</span> Human disease

Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral and sternocostal joints. 90% of patients are affected in multiple ribs on a single side, typically at the 2nd to 5th ribs. Chest pain, the primary symptom of costochondritis, is considered a symptom of a medical emergency, making costochondritis a common presentation in the emergency department. One study found costochondritis was responsible for 30% of patients with chest pain in an emergency department setting.

A diagnosis of exclusion or by exclusion is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or testing. Such elimination of other reasonable possibilities is a major component in performing a differential diagnosis.

Reactive airway disease (RAD) is an informal label that physicians apply to patients with symptoms similar to those of asthma. An exact definition of the condition does not exist. Individuals who are typically labeled as having RAD generally have a history of wheezing, coughing, dyspnea, and production of sputum that may or may not be caused by asthma. Symptoms may also include, but are not limited to, coughing, shortness of breath, excess mucus in the bronchial tube, swollen mucous membrane in the bronchial tube, and/or hypersensitive bronchial tubes. Physicians most commonly label patients with RAD when they are hesitant about formally diagnosing a patient with asthma, which is most prevalent in the pediatric setting. While some physicians may use RAD and asthma synonymously, there is controversy over this usage.

Da Costa's syndrome, also known as soldier's heart among other names, was a syndrome or a set of symptoms similar to those of heart disease. These include fatigue upon exertion, shortness of breath, palpitations, sweating, chest pain, and sometimes orthostatic intolerance. It was originally thought to be a cardiac condition, and treated with a predecessor to modern cardiac drugs. In modern times, it is believed to represent several unrelated disorders, some of which have a known medical basis.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Clouding of consciousness, also called brain fog or mental fog, occurs when a person is slightly less wakeful or aware than normal. They are less aware of time and their surroundings, and find it difficult to pay attention. People describe this subjective sensation as their mind being "foggy".

<span class="mw-page-title-main">History of ME/CFS</span> Aspect of medical history

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has a long history with an evolution in medical understanding, diagnoses and social perceptions.

<span class="mw-page-title-main">Clinical descriptions of ME/CFS</span> Case definitions of the illness

Clinical descriptions of ME/CFS vary. Different groups have produced sets of diagnostic criteria that share many similarities. The biggest differences between criteria are whether post-exertional malaise (PEM) is required, and the number of symptoms needed.

<span class="mw-page-title-main">Medical diagnosis</span> Process to identify a disease or disorder

Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as a diagnosis with the medical context being implicit. The information required for a diagnosis is typically collected from a history and physical examination of the person seeking medical care. Often, one or more diagnostic procedures, such as medical tests, are also done during the process. Sometimes the posthumous diagnosis is considered a kind of medical diagnosis.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

<span class="mw-page-title-main">Myalgic encephalomyelitis/chronic fatigue syndrome</span> Chronic medical condition

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious long-term illness. People with ME/CFS experience a profound fatigue that does not go away with rest, sleep issues and problems with memory or concentration. They are able to do much less than before they became ill. Further common symptoms include dizziness, nausea and pain. The hallmark symptom is a worsening of the illness hours to days after minor physical or mental activity. This "crash" can last less than a day to several months.

Kent Holtorf is an American physician and entrepreneur practicing in Los Angeles, California. He is a board examiner of the American Board of Anti-Aging Medicine (ABAAM), which is not recognized by established medical organizations. He is the founder and medical director of Holtorf Medical Group, a practice with five centers that offer treatment for conditions including fibromyalgia, adrenal fatigue, complex endocrine dysfunction, hypothyroidism, age management, chronic fatigue syndrome, low libido, chronic Lyme disease, migraines, PMS, perimenopause and menopause. His practice focuses on alternative therapies that are not recognised as effective. He has been criticized in the media for his controversial views on topics like bioidentical hormone replacement therapy and vaccines.

Chronic Lyme disease (CLD) is the name used by some people with non-specific symptoms, such as fatigue, muscle pain, and cognitive dysfunction to refer to their condition, even if there is no evidence that they had Lyme disease. Both the label and the belief that these people's symptoms are caused by this particular infection are generally rejected by medical professionals. Chronic Lyme disease is distinct from post-treatment Lyme disease syndrome, a set of lingering symptoms which may persist after successful antibiotic treatment of infection with Lyme-causing Borrelia bacteria, and which may have similar symptoms to those associated with CLD.

<span class="mw-page-title-main">Chest pain in children</span> Medical condition

Chest pain in children is the pain felt in the chest by infants, children and adolescents. In most cases the pain is not associated with the heart. It is primarily identified by the observance or report of pain by the infant, child or adolescent by reports of distress by parents or caregivers. Chest pain is not uncommon in children. Many children are seen in ambulatory clinics, emergency departments and hospitals and cardiology clinics. Most often there is a benign cause for the pain for most children. Some have conditions that are serious and possibly life-threatening. Chest pain in pediatric patients requires careful physical examination and a detailed history that would indicate the possibility of a serious cause. Studies of pediatric chest pain are sparse. It has been difficult to create evidence-based guidelines for evaluation.

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform. The status of ME/CFS as a functional somatic syndrome is contested. Although the aetiology remains unclear, there are consistent findings of biological abnormalities, and major health bodies such as the NAM, WHO, and NIH, classify it as an organic disease.

<span class="mw-page-title-main">Post-exertional malaise</span> Worsening of symptoms with activity

Post-exertional malaise (PEM), sometimes referred to as post-exertional symptom exacerbation (PESE) or post-exertional neuroimmune exhaustion (PENE), is a worsening of symptoms that occurs after minimal exertion. It is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and common in long COVID and fibromyalgia. PEM is often severe enough to be disabling, and is triggered by ordinary activities that healthy people tolerate. Typically, it begins 12–48 hours after the activity that triggers it, and lasts for days, but this is highly variable and may persist much longer. Management of PEM is symptom-based, and patients are recommended to pace their activities to avoid triggering PEM.

Idiopathic chronic fatigue (ICF) or chronic idiopathic fatigue or insufficient/idiopathic fatigue is a term used for cases of unexplained fatigue that have lasted at least six consecutive months and which do not meet the criteria for Myalgic Encephalomyelitis/chronic fatigue syndrome. Such fatigue is widely understood to have a profound effect on the lives of patients who experience it.

References

  1. ↑ 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.
  2. ↑ 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. S2CID   20265782.
  3. ↑ Napodano RJ (1977). "The functional heart murmur: a wastebasket diagnosis". J Fam Pract. 4 (4): 637–9. PMID   853276.
  4. ↑ GAMBILL EE (1960). "So-called mesenteric adenitis. A clinical entity or wastebasket diagnosis?". Minn Med. 43: 614–6. PMID   13703254.
  5. ↑ Eastman M (1978). "Senility: the 'diagnostic wastebasket'". Am Pharm. 18 (10): 53. doi:10.1016/S0160-3450(15)32615-5. PMID   696591.
  6. ↑ 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   2687049 . PMID   18240339.
  7. ↑ Herndon RM (2006). "Multiple sclerosis mimics". Adv Neurol. 98: 161–6. PMID   16400833.
  8. 1 2 3 4 5 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...
  9. 1 2 3 4 5 6 7 8 9 10 Moldofsky, Harvey (2015), Chokroverty, Sudhansu; Billiard, Michel (eds.), "Nonrestorative Sleep, Musculoskeletal Pain, Fatigue in Rheumatic Disorders, and Allied Syndromes: A Historical Perspective", Sleep Medicine, New York, NY: Springer New York: 423–431, doi:10.1007/978-1-4939-2089-1_48, ISBN   978-1-4939-2088-4, PMC   7122008
  10. ↑ "Why You Should Never Settle for an IBS Diagnosis". Bella Lindemann. 2016-11-01. Retrieved 2023-07-08.
  11. ↑ "The Mysteries and Underdiagnosis of SIBO". Time. 2022-03-07. Retrieved 2023-07-08.
  12. ↑ Pfeffer, Glenn B.; Easley, Mark E.; Hintermann, Beat; Sands, Andrew K.; Younger, Alastair S. E. (2017-08-15). Operative Techniques: Foot and Ankle Surgery E-Book. Elsevier Health Sciences. p. 669. ISBN   978-0-323-51191-9. ...the wastebasket diagnosis of 'shin splints' which can be stress fractures, periostitis, or exertional compartment syndrome.
  13. ↑ 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.
  14. ↑ Chelimsky, Thomas C. 2009. “CHAPTER 9: Pain.” In Clinical Adult Neurology, 149–65. Demos Medical Publishing, LLC. ISBN   9781933864358.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ Grossman, Anne Chotzinoff, Lisa Grossman Thomas, Patrick O'Brian (2000). Lobscouse & Spotted Dog: Which It's a Gastronomic Companion to the Aubrey. W. W. Norton & Company. pp. 249–250. ISBN   978-0-393-32094-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
  18. ↑ Burke, Peter; Roy Porter (22 October 1987). The Social history of language. Cambridge University Press. pp. 89–90. ISBN   978-0-521-31763-4.
  19. ↑ Lerner, Barron H. (March 25, 2008). "When the Disease Eludes a Diagnosis (Published 2008)". The New York Times– via NYTimes.com.
  20. ↑ Servan-Schreiber, David; Tabas, Gary; Kolb, N. Randall (March 1, 2000). "Somatizing Patients: Part II. Practical Management". American Family Physician. 61 (5): 1423–8, 1431–2. PMID   10735347 – via www.aafp.org.
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