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. [1] 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.

Contents

The term may also be used pejoratively to describe disputed medical conditions. [2] [3] [4] [5] [6] 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. [7] As diagnostic tools improve, it is possible for these kinds of wastebasket diagnoses to be properly defined and reclassified as clinical diagnoses. [8] Wastebasket diagnoses are often made by medical specialists, and referred back to primary care physicians for long term management.

Specific diagnoses

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. [9] Bronchitis may be used as a trashcan diagnosis to label sick children. [12]

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. [13] [14] [15]

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. [16] 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. [17]

See also

Related Research Articles

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<span class="mw-page-title-main">Cough</span> Sudden expulsion of air from the lungs as a reflex to clear irritants

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<span class="mw-page-title-main">Gastroesophageal reflux disease</span> Medical condition

Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications. Symptoms include dental corrosion, dysphagia, heartburn, odynophagia, regurgitation, non-cardiac chest pain, extraesophageal symptoms such as chronic cough, hoarseness, reflux-induced laryngitis, or asthma. In the long term, and when not treated, complications such as esophagitis, esophageal stricture, and Barrett's esophagus may arise.

<span class="mw-page-title-main">Hiatal hernia</span> Type of hernia

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

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

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Esophageal dysphagia is a form of dysphagia where the underlying cause arises from the body of the esophagus, lower esophageal sphincter, or cardia of the stomach, usually due to mechanical causes or motility problems.

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

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating long-term medical condition. People with ME/CFS experience flare-ups of the illness or crashes following minor physical or mental activity, which is known as post-exertional malaise (PEM) and is the hallmark symptom of the illness. Other core symptoms are a greatly reduced ability to do tasks that were previously routine, severe fatigue that does not improve much with rest, and sleep disturbances. Further common symptoms include dizziness or nausea when sitting or standing, along with memory and concentration issues, and pain.

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 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 chronic fatigue syndrome, 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.

Chronic cough is long-term coughing, sometimes defined as more than several weeks or months. Generally a cough lasting for more than eight weeks for an adult would meet the clinical definition of a chronic cough; and for children this threshold is lower. The term can be used to describe the different causes related to coughing, the three main ones being upper airway cough syndrome, asthma and gastroesophageal reflux disease. It occurs in the upper airway of the respiratory system. Generally, a cough lasts around one to two weeks; however, chronic cough can persist for an extended period of time defined as six weeks or longer. People with chronic cough often experience more than one cause present. Due to the nature of the syndrome, the treatments used are similar; however, there are a subsequent number of treatments available, and the clinical management of the patients remains a challenge. Risk factors include exposure to cigarette smoke, and exposure to pollution, especially particulates.

References

  1. ↑ "trashcan diagnosis" . Retrieved 2008-03-29.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Napodano RJ (1977). "The functional heart murmur: a wastebasket diagnosis". J Fam Pract. 4 (4): 637–9. PMID   853276.
  5. ↑ GAMBILL EE (1960). "So-called mesenteric adenitis. A clinical entity or wastebasket diagnosis?". Minn Med. 43: 614–6. PMID   13703254.
  6. ↑ Eastman M (1978). "Senility: the 'diagnostic wastebasket'". Am Pharm. 18 (10): 53. doi:10.1016/S0160-3450(15)32615-5. PMID   696591.
  7. ↑ 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.
  8. ↑ Herndon RM (2006). "Multiple sclerosis mimics". Adv Neurol. 98: 161–6. PMID   16400833.
  9. 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...
  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. ↑ 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.
  13. ↑ 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.
  14. ↑ 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)
  15. ↑ Burke, Peter; Roy Porter (22 October 1987). The Social history of language. Cambridge University Press. pp. 89–90. ISBN   978-0-521-31763-4.
  16. ↑ Lerner, Barron H. (March 25, 2008). "When the Disease Eludes a Diagnosis (Published 2008)". The New York Times– via NYTimes.com.
  17. ↑ 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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