Sentinel Event Alert 65: Diagnostic overshadowing among groups experiencing health disparities
A 42-year-old woman with a diagnosis of mental illness visited a gastroenterologist after experiencing frequent nausea and stomach pain. The doctor diagnosed functional abdominal pain syndrome (FAPS) and told the patient she would have to “learn to live with it.” Later, the patient discovered FAPS was a “somatization disorder,” meaning that her pain was attributed to her mental and emotional state. The patient lived with the pain and nausea for months and began unintentionally losing weight, which triggered anorexia. Eventually the patient sought out a new gastroenterologist at a women’s medical center. This time, the physician took her symptoms seriously, put her through a series of tests, and after administering a breath test, determined that the patient suffered from small intestinal bacterial overgrowth.
The initial misdiagnosis had a significant impact on the quality of life of this patient, who spent over a year recovering her lost weight and getting her eating disorder under control. This patient still takes medication for her mental illness diagnosis but is tempted to leave these off the medication list she provides to future healthcare practitioners. This was the second misdiagnosis she received in two years, so she worries about disclosing her medication regimen since it may influence how the doctor sees her.
This situation – given from the patient’s point of view – is an example of the risk of diagnostic overshadowing, defined as the attribution of symptoms to an existing diagnosis rather than a potential co-morbid condition. The medical literature includes extensive evidence that diagnostic overshadowing exists within the interactions of clinicians with patients of all ages who have physical disabilities or previous diagnoses such as, but not limited to, autism, mobility disabilities and neurological deficits, as well as patients with conditions or characteristics such as, but not limited to, LGBTQ identifications, history of substance abuse, low health literacy and obesity.
The initial misdiagnosis had a significant impact on the quality of life of this patient, who spent over a year recovering her lost weight and getting her eating disorder under control. This patient still takes medication for her mental illness diagnosis but is tempted to leave these off the medication list she provides to future healthcare practitioners. This was the second misdiagnosis she received in two years, so she worries about disclosing her medication regimen since it may influence how the doctor sees her.
This situation – given from the patient’s point of view – is an example of the risk of diagnostic overshadowing, defined as the attribution of symptoms to an existing diagnosis rather than a potential co-morbid condition. The medical literature includes extensive evidence that diagnostic overshadowing exists within the interactions of clinicians with patients of all ages who have physical disabilities or previous diagnoses such as, but not limited to, autism, mobility disabilities and neurological deficits, as well as patients with conditions or characteristics such as, but not limited to, LGBTQ identifications, history of substance abuse, low health literacy and obesity.