Medical uncertainty leads to “conversion disorder”

Facing medical uncertainty, doctors tell patients it’s all in their heads – By Elizabeth Cohen, CNN – December 21, 2018

When 7-year-old Bailey Sheehan arrived at a hospital in Oregon partially paralyzed, a doctor said the girl was faking her symptoms to get her parents’ attention because she was jealous of her new baby sister.

Those of us with invisible painful syndromes regularly encounter this attitude from medical professionals. When a doctor cannot find some tangible “proof” of our pain, they jump to the conclusion that our problems are mental.

But that doctor was proved wrong when an MRI showed that the girl had acute flaccid myelitis or AFM, a polio-like disease that’s struck hundreds of children since 2014.

What I find frightening and even immoral is that doctors are never reprimanded, rebuked, or in any way penalized for this atrocious conduct, not by their peers, their employers, or medical boards.  

Without any official recognition of these blatant errors and damaging misdiagnoses, there’s nothing to stop this flippant approach to patients with invisible illnesses or pain.

based on postings by parents, as many as 1 in 10 children were told that the paralysis was all in their heads when they first sought medical care.   

Experts who study the art and science of diagnosis say the problem goes beyond this one rare disease.

They say that in general, when presented with a puzzling disease, physicians too often leap to a diagnosis of a psychiatric problem.

Mental disorders become the default position to deal with medical uncertainty,” said Dr. Allen Frances, former chair of psychiatry at the Duke University School of Medicine. “It’s widespread, and it’s dangerous.”

Bailey’s story

Bailey was a healthy little girl until October 28, 2014, when she suddenly couldn’t move her neck or her right shoulder or leg.

A rehabilitation expert at a children’s hospital said Bailey wasn’t really paralyzed, according to her mother, Mikell Sheehan.

He diagnosed Bailey with a mental condition called conversion disorder.

Sheehan told the doctor off.

Good for her! This is a brave response.

“I said, ‘You’ve been with my child for 15 minutes, and you think it’s psychological? Get out of my face,’ ” she remembered.

Sheehan said the doctor hinted that she was unstable.

“He said, you know, ‘moms with new babies don’t get enough sleep,’ ” she said.

So, when they don’t know what’s wrong with a patient they diagnose them as mentally ill and then, if the caregiver protests, they are diagnosed as mentally unstable as well.

Such a diagnosis of mental illness causing your symptoms is entered into your medical record and will follow you around the rest of your life. This carelessly incorrect notation will poison your relationships with all subsequent doctors and make it almost impossible to ever receive appropriate medical care for your symptoms.

Bailey’s regular pediatrician, who’d known the girl since birth, disagreed with the diagnosis and pushed for further testing. That’s when the MRI showed that she had AFM.

Dr. Benjamin Greenberg, a neurologist who’s seen cases of AFM across the country, said that even this year, when AFM has made headlines nationally, parents have told him that doctors have missed the disease and suggested that their children were faking their paralysis.

The dangers of false certainty

Though there’s no data indicating how frequently doctors misdiagnose physical conditions as psychiatric ones, experts in the field of diagnosis say they see it all too often.

When doctors insist that what they cannot see or understand is simply imagined, it absolves them of all responsibility to treat these patients, blithely passing them off to psychiatrists to deal with and hoping they will never have to see these patients again.

And of course, they will not ever know how wrong they were or see the “right answer” to their misdiagnoses because patients will not continue seeing a doctor that insults and dismisses them so handily.

It typically starts when a patient has a perplexing illness and doctors feel a need to come up with a diagnosis.

Doctors are uncomfortable with not having answers,” Frances said.

So they are more comfortable with wrong answers than none.

This is something I noticed in high tech workers as well. Even a completely and obviously wrong answer was preferable to an honest “I don’t know”.

(I see this as a result of the increasing use of meaningless metrics to measure performance.  Many metrics are meaningless because they are devised by managers and accountants removed from the day-to-day work of the people whose “performance” they are supposedly evaluating,)

When such a “wrong answer” sends patients on years of searching to find a cure for their non-existent mental illness, there are no repercussions for the original misdiagnosis.

How can this be called medical care?

The American Medical Association and the American College of Emergency Physicians declined requests for comment.

This is so typical of doctors’ organizations: they close ranks, dig deeper into their position, and refuse to consider they might be wrong.

“Physicians have an obligation to do a thorough workup before turning to a psychological explanation,” he said. “When a doctor can’t find a cause, that’s a great time to get a second opinion or consult with a specialist.”

“Doctors need to learn to embrace medical uncertainty,” he said.

12 thoughts on “Medical uncertainty leads to “conversion disorder”

  1. peter jasz

    Let’s understand something, and make very clear : Physician’s (a definite percentage) are narcissistic assholes.
    They prance around like they “know” what’s going on, when in fact (soon enough) ‘Google Assistant’ will have far better suggestions/possibilities than these ‘hot-shot’ (know squat) physician’s think they now.
    It’s a psycho-pathological condition that many of these high-minded academics suffer. If repercussions weren’t so serious, it would be laughable. Such attitudes/behavior is disgraceful. And exceedingly dangerous.

    And Cyp, when you say (concerned, correctly and accurately) :

    ” ….What I find frightening and even immoral is that doctors are never reprimanded, rebuked, or in any way penalized for this atrocious conduct, not by their peers, their employers, or medical boards.”
    “Without any official recognition of these blatant errors and damaging misdiagnoses, there’s nothing to stop this flippant approach to patients with invisible illnesses or pain.”

    The entire “attitude” starts ‘Top-Down’: Universities/Governing bodies also have this disgraceful , dangerous arrogance, filtered down to their “prized” students/physician’s …

    ALL of them need serious (life-long) lessons in humility (and far greater understanding of human physiology).

    peter jasz

    Liked by 4 people

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    1. Zyp Czyk Post author

      This is so common in so many areas of society that I think it must just be human nature. However, some us make an effort to rise above such base behaviors and hold ourselves to higher standards. Unfortunately, too many do not or cannot, sigh…

      Liked by 2 people

      Reply
  2. Chicago Deb

    I cannot fathom how you can continue to put out these blog posts. Almost every one of them make my blood boil with a renewed anger at how many self-entightled, arrogant, POS, doctors I’ve been misdiagnosed by.
    I cannot correct their records.
    It’s not possible without likely spending big bucks for an attorney.
    I hate 90% of doctors. They are just as bad as bad cops. We need 1st ammendment auditors in every ER. Recordings of every doctor-patient encounter. Peopl would be amazed at the shit they get away with. And they falsify our medical records with opinions, observations so unbelievable, so dead wrong.
    We are helpless.
    We are angry.
    But if we become angry: “The patient appears agitated by a minor error. Prescribed ant-psychotic.” 😂😂😂🙊🙉
    I HAVE EHLERS-DANLOS YOU IDIOTS!!!!

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      Yes, it’s hard not to get sucked into rage & fury, but that would only make me feel even worse. I try not to give mean people more power over me than they already enjoy in this life ;-)

      Liked by 1 person

      Reply
    2. peter jasz

      CD (Deb): I love your passion, openness -and honesty.

      And you’re right, on so many counts.

      I was thinking about the ‘recording’ physician discussions myself; for so many of my encounters with the hillbillies prancing around as medical “specialists” here, their ‘report’ was erroneous, if not insulting as well. It’s disturbing.
      Here in Canada, it’s far worse: (RE: “…Recordings of every doctor-patient encounter. People would be amazed at the shit they get away with.”)

      A major overhaul is demanded. And, sooner rather than later, simple devices such as ‘Google Assistant’ (Medical Edition) along with wearable (medical) devices that soon offer up medical diagnosis, suggestions/recommendations -and eventually set-up appointments !

      Other than actual surgeon’s many other medical professions will, mercifully, disappear -replaced by something far more sensible, honest, ‘timely’ -and accurate !

      peter jasz

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  3. peter jasz

    Hi Cyp: I say this carefully, and respectfully: Those infected psychopaths are particularly dangerous. And obnoxious. Such “personality” traits are particularly damning -and clearly “visible”, if you know what to look for. (I’m speaking of the ones given a position of power that’s abused -routinely, with not a reprimand in sight, or even care to address/correct)

    You know, the academia “know-it-all’s” (yes, physician’s too) who share common, characteristic traits, mostly of the dangerous self-serving type, that’s it’s best to identify -and remain far, far away. Such people are dangerous.

    So, human nature ? Well, in the 1-3% of the population so afflicted -and a high percentage in top positions-, it may seem so. But rest assured, although 1-2-3/100 equals an army of people, mercifully they remain in the minority.

    pj

    Liked by 2 people

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  4. canarensis

    Reminds me somewhat of the neuro who, after seeing me for approximately 15 minutes, declared that my migraines were NOT intractable, a diagnosis that was reached by an outstanding neuro who saw me for nearly 25 years. This same neuro helped tremendously in getting me disability for the intractable migraines. It’s been several years since I saw the jerk, but I continue to have a thread of underlying dread that his miraculous, instant dx of “NOT intractable” will lose me the disability. To say I wish that jackass ill would be an understatement…but if I’d tried to disagree with him on the spot, it’s guaranteed that he would’ve then added psychological disorders to that damning record.

    I think the mother in the post showed remarkable restraint in only going after that incredible jackass verbally. I have no (human) children, but I can’t imagine the level of stress she was under already, with a progressively paralyzed child.

    I used to (attempt to) train residents & new physicians in research laboratory techniques,* and there were many reasons I referred to them as “GITs” (Gods In Training).

    *or I tried to: few of them paid any attention to a mere woman with only ABT of a Masters, despite many years of advanced research lab experience. Even if they didn’t know the difference between a beaker & a Bunsen burner, they “knew” there was no way that I could have anything to teach them.

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  5. Mavis Johnson

    There is no data on any of this by design. These psychological misdiagnosis have been really profitable in many cases. They can be used to explain away incompetence, errors and corruption. The patients can be baled for a surgical mistake or a misdiagnosis that leads to injury or death. A lot of pain patients are the ones who survived these deliberate misdiagnosis, the added stress, postponed medical care, and the stigma can turn a treatable condition into long term chronic pain. The Insurance companies benefit too, they get physicians to act like gate keepers, determining who is worthy of competent health care.

    Liked by 2 people

    Reply
    1. canarensis

      And since society as a whole has jumped onto the national narrative bandwagon (courtesy of the very effective propaganda started by PROP*), the general consensus is that chronic pain patients aren’t worthy of competent health care –or any other kind.

      *I’m sure Himmler is looking up at their efforts with great approval.

      Liked by 2 people

      Reply
      1. Mavis Johnson

        It is a lot more than that. They don’t measure anything that could be unprofitable or make the industry look bad. Pain is inconvenient, an indicator that something is wrong, so they had to pretend it does not exist, and discredit or malign people with pain.

        Liked by 1 person

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