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Irene Lum brings up the interesting subject of medically unexplained symptoms: a burden to doctors and patient alike. It underlines a curious paradox; when diagnosis fails medicine, the response is to create another (in this case, “wastebasket”) diagnosis. That’s not completely surprising. Diagnosis is medicine’s most important classification tool and the foundation for its practice. So, how does medicine account for the things it can’t categorise? It creates a new category…
Early practitioners of scientific medicine seem to have been more patient about cases for which a diagnosis seemed elusive, and we could draw from their wisdom. Dr H Patterson explained to the medical graduates of Pennsylvania College that “The laws of medicine are too undecided still to be susceptible of a perfect codification.” Silas Weir Mitchell reminded doctors that they often need wait before a disorder provides its “definite shape.”
Rather than trying to find a diagnosis for everything, medicine might do well to realise that everything may not be diagnosable. Propst opined in 1939: “It is sometimes impossible to adequately summarize in a name the whole state of a patient's disequilibrium.” This view is echoed by Jerome Kassirer in an era closer to our own: “absolute certainty in diagnosis in unattainable, no matter how much information we gather, how many observations we make, or how many tests we perform… more tests do not necessarily produce more certainty.”
...Show MoreCompeting Interests: None declared.