The path to diagnosis – WHY


Getting the right diagnosis can be life changing. It can mean the end of the pain and the beginning of the answers; it can mean a cure, a cure – or at least a way forward; or it can simply mean validation of everything a patient has experienced.

Diagnosis is at the heart of medicine – and yet it often seems like it goes wrong. Patients sometimes wait months or even years for answers. They suffer endless tests, ineffective treatments, overlooked problems or misdiagnoses. And for some patients, the answers never come at all.

In today’s episode, we walk the long, winding road to diagnosis. We get an inside look at how diagnoses are made, what they mean for and for patients, and the challenges doctors face in making them correctly.

We hear about the dangers of too much testing, the ‘gambling disorder’ debate and a medical mystery from New York Times columnist Lisa Sanders.

Also heard in this week’s episode:

  • Primary care physician Neda Frayha discusses the challenges of making the right diagnosis, the fear of being wrong, why it sometimes takes so long to get answers, and why it’s okay to cry when communicating a difficult diagnosis to a patient. We also hear from another primary care physician, Jay-Sheree Allen, about the importance of taking a good patient history and feeling comfortable with the unknown.
  • In a perfect world, medical tests help narrow down the possibilities, leading to a diagnosis. But sometimes the reverse happens – a suspicious finding leads to further testing, which leads to a visit to a specialist, which leads to scans or x-rays, and so on. It’s what experts call “a cascade of care” – seemingly endless diagnoses that take time, cause anxiety, not to mention cost. In this story from the Tradeoffs health policy podcast, Dan Gorenstein explores what’s behind the care cascade and what it would take to stop it.
  • New York Times “Diagnosis” columnist and physician Lisa Sanders shares one of her latest mysteries — and why confirmation bias can steer healthcare providers in the wrong direction.
  • The World Health Organization recently added a controversial new disease to its comprehensive handbook of diseases: gambling disorder. Journalist Alan Yu examines why gambling disorder has generated so much debate and whether this new diagnosis is really changing the way whose patients are treated.


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