Reflection on a patient encounter: How previous diagnoses can impact bias

I want to reflect on a recent patient I admitted: a woman in her 40s who presented with an intractable headache.

During my review of her medical records, I discovered that she had visited the ED multiple times for issues such as aphasia, weakness and various other nonspecific neurological complaints. Eventually, she received a diagnosis of a neuro/psych disorder after consultations with neurology and psychiatry. They labeled her condition as a neuro-functional complex disorder or conversion/somatic symptom disorder. Once again, during this admission, despite a thorough evaluation in the ED, no conclusive findings were found. To ensure completeness, we also ordered a lumbar puncture. Her headaches were managed with as-needed nonsteroidal anti-inflammatory drugs, and neurology was consulted. I thought I had completed her admission; however, a few hours later, I received a call revealing an elevated opening pressure, suggesting another potential cause for her headaches.

This particular case prompted me to reflect on the harm we can unknowingly inflict on patients who have a preexisting diagnosis related to their personality or psychological state. This patient potentially had an underlying condition that was missed, but my initial thought process was, “If no one else has identified an underlying pathology for her symptoms in the past, it's unlikely that I will.” This type of thinking can lead to errors. While the appropriate steps and treatments were taken, I believe it is crucial to approach every patient with an unbiased perspective, regardless of established diagnoses.

Consider patients with personality disorders as another example. How often do we attribute their behavior solely to a distant diagnosis of bipolar disorder or borderline personality disorder? Do they not experience the same range of emotions that we do — joy, anger, sadness, frustration? In fact, perhaps they don't even have the diagnosis in question. I view this situation as an opportunity for growth and improvement. A diagnosis, whether mental or physical, should not define a person.

In conclusion, this patient encounter has reinforced the importance of approaching each individual without bias, irrespective of previous diagnoses. By doing so, we can ensure that we provide the highest quality of care and avoid overlooking potential underlying conditions. Let us remember that a diagnosis should never overshadow the complexity and uniqueness of each person we encounter.