Diagnostic Overshadowing 

— defined as the misattribution of symptoms to an existing diagnosis rather than a potential co-morbid condition, leading to compromised patient care.

This topic was prompted by a tweet and by a comment yesterday from a parent referring to her son’s chronic oesophageal spasms. 

We highlighted the importance of getting any new or worrying chronic symptoms checked by the doctor and to not always assume that it’s just ME.

ME patients and their doctors should be aware of the risks of diagnostic overshadowing i.e., the misattribution of new illness signs/symptoms to underlying disability and other erroneous assumptions that may affect timeliness of new illness diagnosis and quality of care.

Diagnostic overshadowing stems from cognitive bias. Once an initial diagnosis has been made, momentum sometimes takes hold and reduces a clinician's ability to consider other alternatives. This bias can affect future patient workups and how handoffs to other providers are framed.

Additionally, time pressures faced by clinicians can cause them to hurry or to be impatient. As a result of time pressures and other factors, patients are often unable to present a complete or accurate narrative of their symptoms, medical histories and current medications.

More about Diagnostic Overshadowing in a paper called ‘Diagnostic Overshadowing Worsens Health Disparities’ 

07/27/2022 from The Joint Commission dot org (US)

https://www.jointcommission.org/resources/news-and-multimedia/blogs/advancing-health-care-equity/2022/07/diagnostic-overshadowing-worsens-health-disparities/

Diagnostic overshadowing is a form of diagnostic error that can cause harm to any patient regardless of age. It also can occur to virtually any patient with a pre-existing diagnosis or condition.

(Diagnostic overshadowing originally referred mostly to pre-existing mental health diagnoses overshadowing the possibility of any physical diagnosis)

Suggested actions re avoiding diagnostic overshadowing 

 

When you find your medical symptoms marginalized or dismissed by your healthcare professional as a possible result of your ME/other diagnosis, try the following:

• Find your voice. Ask: What tests would you suggest if you weren’t dealing with a person with ME? 

• Explain in a strong and reasonable voice to your doctor that you feel your doctor isn’t really listening to you.

• Using the phrase diagnostic overshadowing will alert your doctor that not only are you well-informed about things, but that you need him or her to check their bias.  

 

• Ask for more tests. If there is room in your doctor visit to be proactive, ask your physician, “How might you address my physical complaints if I didn’t have ME?” “What tests would you order if I wasn’t someone with ME?” By doing this, you subtract the ME associated presumptions from the medical equation.

• There’s strength in numbers, so if you’re working with a doctor who's fallen into diagnostic overshadowing ask your consultant(s)/other healthcare provider(s) to talk with your doctor. Sometimes other professionals can bring up stigma related issues more effectively. 

 

• Doctor shop. If you find that interventions you’ve made haven’t made diagnostic overshadowing fade away, perhaps it’s time to find a new healthcare professional. 

 

It’s vital to move forward if you have another medical issue. Don’t let the bias of doctors keep you from finding good healthcare.