Diagnostics, diagnostics and more diagnostics

By Dr. Javier Rivera | Oct. 15, 2018 | Posts in English

(Para leer en español, pincha aquí)

This is what happens to many people with fibromyalgia and, without a doubt, it is a serious problem.

Over diagnosing means making the diagnosis of a disease that does not produce any symptoms in the person and that will not produce them in the future. In other words, if this diagnosis is not made, there will be no consequences for her/his life.

How can this happen, you ask? Well, you will understand it easily after some explanations.

The most frequent cause for overdiagnosis is precisely the performance of unnecessary diagnostic tests since, with some frequency, some alterations are found that have no clinical significance. These alterations do not explain what is happening to the patient but are enough to establish a new diagnosis.

For example, did you know that in 5% or 15% of abdominal imaging tests (X-ray, ultrasound, scanner or magnetic resonance) performed on people without any clinical manifestations, something unexpected is found? This means that new tests will then be requested to continue studying the finding and establish a diagnosis.

In blood tests it is still more common to find alterations that have nothing to do with what we are looking for. These are the cases of small elevations of cholesterol or uric acid, low levels of iron or vitamin D, various genetic markers (such as those of celiac disease, for example) or minimal alterations of the defenses, which in no case satisfactorily explain the symptoms of the patient.

Making a diagnosis also has a number of negative consequences for the patient. The first is the psychological impact that, depending on the importance of the diagnosis, will produce more or less worry and anxiety. But it also has other consequences such as the performance of more tests, repercussions on the personal, family or work life of the patient and on many occasions on his economy.

The most serious of all the consequences is, of course, the treatment that is given, either in the form of drugs or in the form of surgical interventions. In these cases no benefit can be expected –because the patient did not have any problems previously– and all that can be found are negative consequences. Remember that there is no harmless drug and no risk-free surgical intervention.

People with fibromyalgia are especially susceptible to overdiagnosis for a variety of reasons. Before being diagnosed with fibromyalgia they have been going around numerous consultations undergoing multiple tests and it is easy that something has been found in some and a diagnosis has already been made. That is why it is so common to see people who, when we finally make the diagnosis of fibromyalgia, already have a string of varied diagnoses with their respective treatments.

Fibromyalgia is a disease with many symptoms and when they are misinterpreted in isolation, rather than all as part of the same disease, it is very easy for multiple diagnoses to be made. We have already discussed this in a previous article that I recommend you to read (click here).

In conclusion, people with fibromyalgia have a high risk of suffering from overdiagnosis and this situation only produces negative consequences and no positive ones. The person with fibromyalgia should be very aware of these risks and try to avoid them by talking with their doctor about the possible benefits that can be expected from any test that is ordered.

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