Wastebasket diagnosis

A wastebasket diagnosis or trashcan diagnosis is a vague diagnosis given to a patient or to medical records department for essentially non-medical reasons.[1] It may be given when the patient has an obvious but unidentifiable medical problem, when a doctor wants to reassure an anxious patient about the doctor's belief in the existence of reported symptoms, when a patient pressures a doctor for a label, or when a doctor wants to facilitate bureaucratic approval of treatment.

The term may also be used pejoratively to describe disputed medical conditions.[2][3][4][5][6] In this sense, the term implies that the condition has not been properly classified. It can carry a connotation that the prognosis of individuals with the condition are more heterogeneous than would be associated with a more precisely defined clinical entry.[7] As diagnostic tools improve, it is possible for these kinds of wastebasket diagnoses to be properly defined and reclassified as clinical diagnoses.[8] Wastebasket diagnoses are often made by medical specialists, and referred back to primary care physicians for long term management.

Specific diagnoses

Common wastebasket diagnoses include:

Reactive hypoglycemia has been used as a trashcan diagnosis for people who complain about normal physiological reactions to being hungry. In these cases, the labels are offered when nothing more serious can be identified.[9] Bronchitis may be used as a trashcan diagnosis to label sick children.[10]

History

Fake diagnoses are not a modern invention. Medicine around the world has a long history of using and abusing the concept of trashcan diagnoses, from "rectifying the humors" to marthambles to neurasthenia to garbled Latin-sounding names which were made up to impress the patient's family.[11][12][13]

Management

The medical community is often split on the best approach to managing a wastebasket diagnosis. The biggest challenge for a physician is maintaining their interest and desire to see the patient through their illness.[14] Antidepressants and cognitive therapies are commonly employed, speaking to the possible emotional basis that underpins these diagnoses or the physician's effort to psychopathologize the patient whose disorder the physician can not identify.[15]

See also

References
  1. "trashcan diagnosis". Retrieved 2008-03-29.
  2. Smith TL (2003). "Vasomotor rhinitis is not a wastebasket diagnosis". Arch. Otolaryngol. Head Neck Surg. 129 (5): 584–7. doi:10.1001/archotol.129.5.584. PMID 12759275.
  3. Rauh SM, Schoetz DJ, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1991). "Pouchitis--is it a wastebasket diagnosis?". Dis. Colon Rectum. 34 (8): 685–9. doi:10.1007/BF02050351. PMID 1649737. S2CID 20265782.
  4. Napodano RJ (1977). "The functional heart murmur: a wastebasket diagnosis". J Fam Pract. 4 (4): 637–9. PMID 853276.
  5. GAMBILL EE (1960). "So-called mesenteric adenitis. A clinical entity or wastebasket diagnosis?". Minn Med. 43: 614–6. PMID 13703254.
  6. Eastman M (1978). "Senility: the 'diagnostic wastebasket'". Am Pharm. 18 (10): 53. doi:10.1016/S0160-3450(15)32615-5. PMID 696591.
  7. Freeman HJ (2008). "Refractory celiac disease and sprue-like intestinal disease". World J. Gastroenterol. 14 (6): 828–30. doi:10.3748/wjg.14.828. PMC 2687049. PMID 18240339.
  8. Herndon RM (2006). "Multiple sclerosis mimics". Adv Neurol. 98: 161–6. PMID 16400833.
  9. Barron H. Lerner, MD (25 March 2008). "When the Disease Eludes a Diagnosis". New York Times. Retrieved 2008-03-29. For example, many patients with chest pain carry a diagnosis of costochondritis (inflammation of the chest wall bones) or gastroesophageal reflux (regurgitation of stomach acid into the esophagus). These are real conditions. But they tend to generate little interest from many physicians, who may refer to them as 'wastebasket diagnoses,' offered when nothing more serious has turned up. The frustration of patients who believe that the medical profession takes these types of ailments too lightly has led groups of them to form alliances to publicize their illnesses. Foremost among them are fibromyalgia, a syndrome involving muscular and other pains, and chronic fatigue syndrome...
  10. Randall G. Fisher; Thomas G. Boyce; Hugh L. Moffet (2005). Moffet's Pediatric Infectious Diseases: A Problem-oriented Approach. Lippincott Williams & Wilkins. pp. 145–. ISBN 978-0-7817-2943-7.
  11. Thompson, C.J.S. (January 24, 2003) [1928]. Quacks of Old London. Kessinger Publishing. p. 80. ISBN 978-0-7661-3609-0. Retrieved February 11, 2012.
  12. Grossman, Anne Chotzinoff, Lisa Grossman Thomas, Patrick O'Brian (2000). Lobscouse & Spotted Dog: Which It's a Gastronomic Companion to the Aubrey. pp. 249–250. ISBN 978-0-393-32094-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
  13. Burke, Peter; Roy Porter (22 October 1987). The Social history of language. pp. 89–90. ISBN 978-0-521-31763-4.
  14. "When the Disease Eludes a Diagnosis (Published 2008)". March 25, 2008 – via NYTimes.com.
  15. Servan-Schreiber, David; Tabas, Gary; Kolb, N. Randall (March 1, 2000). "Somatizing Patients: Part II. Practical Management". American Family Physician. 61 (5): 1423 – via www.aafp.org.
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