What is it about?
The term 'medically unexplained symptoms' (MUS) refers to conditions for which medical examination yields no biomedical evidence to corroborate the patient's symptoms. In this article, MUS is used as a prism to understand the logic of diagnostic classification in situations where medical examination does not unilaterally indicate a diagnostic category, that is, when there are no strong medical warrants for choosing one category (e.g. wheezing) over another (e.g. asthma). Such situations are typical in primary care, occurring whenever ambiguous or complex conditions must be classified within the discrete niches of the International Classification of Primary Care. The question is how, in these instances, doctors choose between official diagnostic categories.
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Why is it important?
Based on focus group data, the analysis show that general practitioners (GPs) are concerned with the anticipated consequences of using this or that diagnosis (how it will affect patients, bureaucrats or insurance sellers), and that this affects their approach to diagnosing MUS. As a result, diagnostic categories are not used as descriptions of the patients' symptoms, but as clinical tools to therapeutic ends. In other words, the GPs adopted a pragmatic attitude, emphasising the future consequences rather than the present veracity of diagnostic categories. Consequently, treatment and diagnosis seemed to converge.
Perspectives
When doctors diagnose patients, they must answer two related questions. The first question is 'what is happening with the patient?', and relates specifically to what the doctor thinks is going on. The second question is 'what diagnostic category of the ones available to me should I confer in this case?', and relates to the assignment of official diagnostic labels. I.e., the first question relates to what the doctor thinks, the second to what (s)he does. The theoretical understanding of diagnosis has tended to focus on what doctors think, and to overlook the bureaucratic activity of assigning official diagnostic categories to people. Most likely, this is because of a tendency to assume that the answer to the second question follows unproblematically from having answered the first. In this paper, I show that this assumption is unwarranted, and that there is explanatory power and insight to be gained from pursuing how doctors answer this second question.
Erik Rasmussen
Norsk institutt for by- og regionforskning
Read the Original
This page is a summary of: Balancing medical accuracy and diagnostic consequences: diagnosing medically unexplained symptoms in primary care, Sociology of Health & Illness, May 2017, Wiley,
DOI: 10.1111/1467-9566.12581.
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