Tag Archives: Diagnostic Error

Can Symptoms Be False?


Having a person come into a clinician’s office and presenting with symptoms of one or more disorders can be a tricky process for the clinician to try to diagnose, even without the presence of factitious symptoms.  The presence of factitious symptoms can make the diagnosis very complicated because the clinician would need to have the patient go through their history, which would be a normal step, but then if the clinician suspects any kind of factitious disorder, generally a more thorough history would be required.  Because the person feels a need to continue to be sick they would be complaining of the same symptoms over and over again, or possibly complaining of the symptoms getting worse.  The problem would be that there isn’t anything real to back it up.  A misdiagnosis would come into play, probably several times. It could be possible that factitious disorders are responsible for the averages given when it comes to the length of time it takes to diagnose.

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People who suffer from factitious disorder don’t have an ulterior motive, people who malinger do.  Malingering is when someone gives factitious symptoms in order to gain something.  Malingering generally causes a person to choose not to follow a Doctor’s reference for psychiatric care.  In rare cases when someone who is malingering does choose to seek psychiatric help, the sessions don’t offer any kind of help to further the person’s treatment.  There are various things that motivate a person to malinger.  These could include trying to gain material items such as a car or jewelry or to win a lawsuit for monetary value.  It could also be something as simple as to gain someone’s attention.

Between having patients come in with factitious symptoms either controlled or uncontrolled and people who are malingering, it is easy to see how a clinician would need to be extremely cautious when it comes to giving a diagnosis.

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References: Malingering. Psychnet-uk.com.;  The Unexplained. Bellevue.edu

Ooops! …on the potential for malpractice when serving diverse populations.


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If there is anything that keeps a therapist up at night, it’s the potential for a malpractice suit… misdiagnosis, diagnostic errors, and/or delayed diagnosis are at the forefront of our concerns.  “What if I get it wrong?”

Braun & Cox (2005) suggest some measures that can be implemented to reduce likelihood of getting into this legal or ethical dilemma.  Informed consent can help clients understand benefits, and allow the clinician to properly set expectations around the services that are covered… especially with regard to termination since additional sessions are likely to be expensive in some cases.  Furthermore, clients need to be aware that counselors can no longer ensure privacy of disclosure because managed care organizations (MCOs) may require sensitive information.  The release of this information may precipitate changes in treatment and outcome due to the fact that MCOs typically determine the type of treatment that should be employed and/or would be covered.  We would also need to familiarize ourselves with “brief therapy models” in order to be competent at providing services through MCOs.  (Braun & Cox, 2005, p. 426)  If we intend to work with this specific client population we need to be well versed in all of the above considerations before we even consider taking a client that intends to utilize them as a 3rd party payer.

Although I do not consider it to be a personal deficit, historically, there is a general mistrust and underutilization of the medical and mental health communities as it relates specifically to people of color.  Adequately addressing this climate of mistrust demands that we engage in an “honest and thorough self-examination of conscious and unconscious attitudes about race and the legacy of racism in the United States.”  (Suite, La Bril, Primm, & Harrison-Ross, 2007, p. 883)  Furthermore, Suite and associates (2007) suggest we “keep at arm’s length assumptions of cultural homogeneity and offer contextually based mental healthcare.”  They define contextually based mental healthcare as “extensive and critical interpretation of the historical, cultural, spiritual, political, social and philosophical underpinnings of racism in medicine and draw connections on how these factors impact the self-identities of communities and individuals therein.”  In my opinion, it is absolutely imperative that we attempt to understand how individual people of color perceive mental healthcare as an institution, as well as rebuild trust in the institution as a whole by delivering culturally sensitive options at every step of the therapeutic process.

References

Braun, S. A., & Cox, J. A. (2005, Fall). Managed mental health care: Intentional misdiagnosis of mental disorders. Journal of Counseling and Development : JCD, 83(4), 425-433. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=916199881&sid=10&Fmt=3&clientId=4683&RQT=309&VName=PQD

Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007, Aug). Beyond misdiagnosis, misunderstanding and mistrust: Relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99(8), 879-885. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1319356711&sid=10&Fmt=3&clientId=4683&RQT=309&VName=PQD

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