How Do I Minimize the Chance of Misdiagnosing Someone?

As psychologists, the accuracy of our diagnoses is essential. Misdiagnosis can lead to incorrect treatments, prolonged suffering, and loss of trust in mental health services. Therefore, it is necessary to refine our diagnostic skills and approaches continuously. Here are seven strategies to minimise the risk of misdiagnosing someone.

1. Comprehensive Assessment

A comprehensive assessment, the foundation of accurate diagnoses, should include quantitative and qualitative methods. Use a thorough interview to gather a complete history of the patient's mental health, physical health, life circumstances, and family background. Supplementing the interview with standardised assessment tools or questionnaires can provide additional insights and help avoid personal biases.

Quantitative and qualitative data are essential as both approaches have strengths and limitations. If we rely too heavily on standardised measures, we miss the nuance of that person's experience. If we only use qualitative methods, we cannot quantify symptoms and their severity and measure progress over time.

2. Emphasising Differential Diagnosis

Differential diagnosis is a systematic method used to identify the presence of a psychiatric condition where multiple alternatives are possible. This process involves comparing and contrasting the symptoms presented by the patient with various known disorders. We arrive at a more accurate diagnosis by considering all possible conditions and systematically ruling out each one. Of course, this takes considerable knowledge and skill. To know what to look for and how symptoms may manifest differently, you must ensure you are current with the literature. See more on this below.

Differential diagnosis also includes considering the physical health of your patient. Physical health issues and certain medications may contribute to the manifestation of psychological symptoms. For instance, thyroid disorders can mimic depression or anxiety, and neurological conditions can present psychiatric symptoms. Consider referring your patient to a medical practitioner for a complete physical examination to rule out or identify any underlying medical conditions.

3. Cultural Competence

Cultural factors can significantly influence how symptoms are experienced and expressed. Being culturally competent means understanding and respecting patient's diversity. A lack of cultural competence can substantially contribute to missed or misdiagnosis.

When going through the assessment and diagnosis process, ensure that your approach to diagnosis considers the patient's cultural background, religion, language, neurotype, and whether they belong to any other minority group. Suppose this is a minority group you do not have experience working with. In that case, you must revisit the current literature, seek supervision, or attend relevant training to understand how to consider this diversity in your diagnostic process.

4. Continuous Learning and Supervision

Psychology is a constantly evolving field, and it is our responsibility as practitioners to keep up to date with the literature. Engaging in ongoing education through self-directed learning or attending workshops is essential. Seeking supervision or consultation with psychologists with expertise in your practice areas can provide fresh perspectives and insights into complex cases. It also ensures we have a second eye on more challenging cases.

This continuous learning process is vital for keeping up-to-date with the latest in assessment and the nuances of diagnostic criteria. Understanding diagnostic criteria, how they manifest differently across different population groups, and their comorbidities is one of your best tools for achieving accurate diagnoses.

5. Multiple Informant Reports

When possible, gather information from multiple sources to assist you with making an accurate diagnosis. Reports from family members, teachers, or others who know the patient well can provide additional context and insight, especially when diagnosing children or adolescents. With complex cases, informant reports are invaluable, but they should not take priority over your patient's self-reports and exploration of their internal experiences. Remember, many psychiatric diagnoses do not always manifest as behaviours we or others can observe. We must genuinely seek to understand our client's internal world to aid us.

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6. Watch for Comorbidities

Mental health issues rarely occur in isolation, which can complicate the assessment process and lead to misdiagnosis if overlooked. Be vigilant about the possibility of comorbid conditions. A patient presenting with depression, for example, may also be experiencing an anxiety disorder. Someone who has ADHD may also be autistic. Be familiar with commonly co-occurring conditions and always consider screening for both things. We aim not to provide multiple unnecessary diagnoses to our patients; instead, we ensure we capture the whole picture so they get the most appropriate care.

7. Prioritise the Patient's Well-Being

Finally, always prioritise the patient's well-being in your diagnostic process. Ensure the approach is empathetic, respectful, and centred around their needs and concerns. The assessment process can be uncomfortable and has the potential to trigger unresolved feelings and trauma for your patient. Hold space for this and approach this with care.

Prioritising your patient's well-being means that we also validate and explore their concerns. Medical gaslighting, where patients feel dismissed or doubted by health care providers, is a significant concern, especially among women and other minority groups. If your patient comes to you with a diagnostic hypothesis, do not dismiss this automatically because they don't meet stereotypes. We have a responsibility to take our patients seriously, and this at times means exploring our own biases and preconceived ideas. Ensure your due diligence by conducting a thorough assessment, making your patient feel safe and validated. Even if the patient's diagnostic prediction turns out to be wrong, it is important for their well-being and their confidence in you that they feel taken seriously.

Conclusion

Minimising the risk of misdiagnosis is a multifaceted process. It requires a blend of comprehensive assessment, continuous education, awareness of personal biases, and an understanding of the complex interplay between physical, psychological, and cultural factors. As psychologists, our commitment to these principles not only enhances the accuracy of our diagnoses but also upholds the trust and integrity of our profession. Remember, a diagnosis is a means to an end—the end being effective treatment and support for the patient.