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Good Diagnoses?

Good Diagnoses?. Discussion of Two Diagnoses of doubtful validity. History #1. 21 year old female with no PMH except 1 episode of mild depression. Trivial seeming injury followed by exhaustion, recurrent headaches, difficulty finding words. Several months of struggling to find a cause.

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Good Diagnoses?

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  1. Good Diagnoses? Discussion of Two Diagnoses of doubtful validity.

  2. History #1 • 21 year old female with no PMH except 1 episode of mild depression. • Trivial seeming injury followed by exhaustion, recurrent headaches, difficulty finding words. • Several months of struggling to find a cause.

  3. Outcome • Gradual deterioration in functioning and withdrawal from activities. • When I left, was living back at home managing to make 1 journey down the stairs and one back up per day.

  4. Questions How far can you blame the label for the outcome? What approaches are there to CFS?

  5. CFS • NICE guidance; • 1.1.1.4 Healthcare professionals should recognise that the person with CFS/ME is in charge of the aims and goals of the overall management plan. The pace of progression throughout the course of any intervention should be mutually agreed.

  6. NCFSFA.org Page titled “LEARNING TO COPE” “Comes only after the knowledge that the medical community does not have “the answer” for CFS. Patients must reach within their beings to find the tools to live with this illness.....Also, they can work with their physician in being a “partner” in their own healthcare.”

  7. History #2 • 35 year old paramedic with a 1 year history of a range of symptoms; exhaustion, urinary symptoms, fevers and various collapses. • Negative investigations by urologists and medics. • Several different causes suggested by us and all rejected.

  8. Outcome • Self referred to GUM for a recurrent discharge and persistent leucocytes in urine. • Diagnosed with “desquamativevaginitis”. • Diagnosed with vitamin D insufficiency.

  9. Question What are the possible consequences for us of going along with a diagnosis we think is false? Is it unethical to pretend we agree?

  10. Conclusions • “Soft” diagnoses can be useful but are also carry dangers with them. • Maybe if a doubtful diagnosis becomes inevitable, we could try and use aspects of the diagnosis we agree with.

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