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Dealing with medical uncertainty, doctors say patients are all in their heads



But that doctor proved wrong when an MRI showed that the girl had a chronic myelitis or AFM mosquito, a polio-like illness that had suffered hundreds of children since 2014. [19659002] Erin Olivera, mother of a kid with AFM and founder of a private Facebook page for parents of 400 children with illness, says Bailey's experience is slightly different. He estimates that based on parents posting, as many as 1 in 10 children have been told that paralysis is all on their heads when they first seek medical care.

Experts who study art and science of diagnosis are a rare disease. They say that in general, when presented in a puzzling illness, physicians often leap into a diagnosis of a psychiatric problem.

"Mind disorders have become the default position to deal with medical uncertainty," says Dr. Allen Frances, former chair of psychiatry at the Duke University School of Medicine. "It's wide, and it's dangerous."

Dr. Mark Graber, president of the Society to Improve Medical Evidence, added, "It is a habit with physicians when they can not find a physical cause.

" Bad. Bailey was a healthy girl until October 28, 201

4, when she suddenly did not move her neck or the right shoulder or toes.

A rehab expert at a children's hospital told Bailey that he was not really paralyzed, according to his mother, Mikell Sheehan.

The doctor said that paralysis was an emotional reaction to his sister's birth four months earlier.

Sheehan told the doctor.

  Bailey Sheehan was diagnosed with AFM after his mother disagreed with the first test.

"I said, 'You are with my child for 15 minutes, and do you think it is psychological? Take my face, 39; "he recalls.

Sheehan said the doctor indicated he was unstable.

"She said, you know, 'mothers with new babies are not asleep enough," she says. .

Bailey's regular pediatrician, who had met the girl since birth, disagrees with the test and pushed for further examination. That is when MRI showed that he had AFM.

Obtained the correct diagnosis, received by Bailey The AFM, including extensive physical therapy, and four years later goes on again.

"We are fortunate that his pediatrician is like the advocate for us, but I do not know if everyone is lucky," Sheehan said.

Sheehan says she understands why doctors did not immediately think of AFM for her daughter, since the disease was unknown four years ago. But there are some other reasons for paralysis of children, and she wonders why her daughter did not get a full round of testing for them.

  Record number of cases of polio-like AFM in the US this year

Dr. Benjamin Greenberg, a neurologist who has seen AFM cases nationwide, said that even this year, when AFM made headlines nationwide, parents told him that doctors were not taken the disease and suggested that their children violate their paralysis.

"The stories I can say are disturbing and saddening," says Greenberg, associate professor of neurology at UT Southwestern Medical Center.

Four years later, Sheehan says, he still feels the scars of his daughter's misdiagnosis.

"You feel guilty and wrongfully accused," she said.

The dangers of false certainty

Although no data indicates how often doctors treat physical conditions as psychiatrists, experts in the field of analysis say that they are very frequent.

It usually begins when a patient has an illness and the doctors feel that there is a diagnosis.

"Doctors are uncomfortable with not having answers," Frances says.

The consequences can be "catastrophe," he said, because a misdiagnosis can lead to a patient receiving treatment for an illness that is missing and missing out on treatment for the illness they have.

"Misidentification is more dangerous than uncertainty," he said.

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

Graber, professor of medical emeritus at Stony Brook University in New York, said that part of the problem was that medical students pointed out that physical symptoms sometimes had a psychological basis. That is true, he said, but physicians need to thoroughly examine physical problems before being defaulted on a psychiatric diagnosis.

"The physicians have an obligation to make a thorough workout before going to a psychological explanation," he said. "When a doctor finds no reason, it's a good time to get a second opinion or consult a specialist."

Frances added that it is right for a doctor to say "I do not know."

"Doctors need to learn to cover medical uncertainty," she says.


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