uncertainty and psychosomatic dx

Diane O'Leary doleary8 at UWO.CA
Thu Jul 4 17:34:26 UTC 2019

On the issue of diagnostic uncertainty, here’s a terrific long-term study that concludes “there is a high possibility of misdiagnosis among patients diagnosed with ‘psychogenic’ disorders or ‘psychosomatic’ disease”.  There’s an insightful analysis of reasoning errors here, along with four central case studies.

“Avoiding diagnostic errors in psychosomatic medicine: a case series study”, Koyama et al. BioPsychoSocial Medicine (2018) 12:4.


Nimnuan et al (2001) found that 17% of initial psychosomatic diagnoses are mistaken in secondary care.  That figure is alarming when we note the large portion of patients with medically unexplained symptoms.  If a third of new sx are MUS, the 17% error rate tells us that for every doctor, more than 8 patients per week are likely to be denied the medical testing and treatment they need.  (I’m assuming a 20 patient per day load, where half seek care for new sx.)

MUS are the largest patient group by far.  It seems important to bring them into the general discussion of uncertainty and dx error.


Diane O'Leary, PhD

Visiting Professor, Rotman Institute of Philosophy
London, ON Canada
(518) 275-5843
(226) 215-4198
doleary8 at uwo.ca

Adjunct Full Professor and Course Chair in Philosophy
University of Maryland University College
Adelphi MD
diane.oleary at faculty.umuc.edu

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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