With the Internet many patients visit the GP after extensive searches on the Internet. They usually have an idea about what’s wrong with them. In a recent publication in the British Medical Journal I found a recent article on this subject. In visits to a GP patients the self diagnosis (also called self labelling) was responsible for initiating a diagnosis in 18% of consultations.
Few studies have been done on the accuracy of self diagnosis. These studies suggest that recurrent urinary tract infection, recurrent anterior uveitis, schistosomiasis, and head lice can all be self diagnosed correctly.
There are also studies suggesting that certain conditions are often misdiagnosed by patients. Examples from the literature search include pregnancy, vaginal candidiasis, and scabies.
Patients with recurrent conditions and chronic diseases are often experts about their illness. A collaborative approach within a traditional diagnostic framework with these patients yield the most satisfying results for all.
Prevalence, previous episodes, general awareness of condition, and patient education affect the accuracy of self diagnosis. Self diagnosis should always undergo subsequent refinement and challenge.
Excellent article, should have been free access.
Goyder, C., McPherson, A., & Glasziou, P. (2009). Self diagnosis BMJ, 339 (nov11 1) DOI: 10.1136/bmj.b4418
A recent study published in Medical Education demonstrated that undergraduate medical students react less positively towards mentally ill patients in primary care than to patients in good health or with a chronic physical illness, such as diabetes.
Despite striving to promote knowledge and skills related to the recognition and management of patients with mental illness by the General Medical Council (GMC) and UK medical schools. Moreover, general clinical and psychiatric training had little effect on these reactions.
Concerns that the students appears to have with patients with mental illness ?
Their perception that mental health patients will take up more time. This may be accurate as mental health care users do have higher consultation rates than the general population and take more time to evaluate these patients.
They think that mental ill patients use more illegal drugs and they are concerned about child welfare of parents with mental illness. But substance abuse is generally found more frequently in young men with antisocial characteristics instead of schizophrenia. Children of parents with mental illness may be exposed to considerable psychosocial and genetic risks but this shouldn’t exclude the care for these patients, it should promote the health care.
The students still have the perception that mental illness patients in the community have an
increased risk of violence. This is not true. This is a common view fuelled by media coverage.
In Schizophrenia the students presume compliance to be a bigger problem and they are less likely to undertake health promotion activities such as exercise and healthy diet.
Students also thought that the patient with depression was deemed more likely to drink to excess than those with other diseases.
Students need to appreciate that although patients with mental health problems may, as a group, be more difficult to manage than other patient groups, this does not mean that all – or even the majority – of such patients will be.
Even when they are more difficult to manage they still have a disease comparable to somatic illness or even worse, that should be treated. On emergency rooms these patients also tend to be neglected out of fear or countertransference. Suicidal patients are often seen as a bother on ER department. Also care of their somatic illnesses tend to be under treated and neglected.
Although this study was undertaken in a single institution, Birmingham Medical School is one of the largest schools of medicine in the UK.There seems to be no reason why the results reported here should not be generalisable to all UK medical schools.
And there seems to be no reason why the results reported here should not be generalisable to other countries such as The Netherlands or the US.
How did they study this?
A sample of 1239 students from the University of Birmingham Medical School were each given one of four case vignettes, all of which were identical except that the patient involved was described as having a previous diagnosis of, respectively, schizophrenia, depression, diabetes or no illness. Students rated their level of agreement with 12 attitudinal statements relating to the vignette.
How to fight this?
Improve medical education. The authors suggest that because personal experience with mental illness lessens the negative attitude students have towards mental illness they should attend the presentation of autobiographical cases which allow the disease to be viewed within the context of an individual’s entire life. This can be accomplished by reading autobiographical books or see films such as “A beautiful mind” or talk to these patients and integrate this in the education.
What do you thinks as patient and/or physician?
Robert P Dixon, Lesley M Roberts, Stephen Lawrie, Lisa A Jones, Martin S Humphreys (2008). Medical students’ attitudes to psychiatric illness in primary care Medical Education DOI: 10.1111/j.1365-2923.2008.03183.x