Vice has an excellent article on reasons that patients with "long Covid" have not been taken sufficiently seriously, often been dismissed by their physicians as experiencing stress or anxiety. This is part of a long-standing phenomenon of diagnosing "medically unexplained symptoms (MUS)" for patients whose physical complaints are not confirmed by currently available tests. As the author Alan Levinovitz put it, too many physicians readily "jump from 'I don’t know' to a psychological diagnosis."
How long does it take for a general practitioner to diagnose medically unexplained symptoms? Like everything related to diagnostic uncertainty the question is understudied. The first quantitative study addressing it was published in January of 2020, just as the WHO began to warn about coronavirus. Researchers from the Netherlands recorded consultations and then played them for general practitioners, asking them to pinpoint when they made the determination of MUS. Since MUS is a diagnosis of exclusion—that is, all other possible etiologies must be eliminated—it ought to take longer to arrive at than other diagnoses, and only after taking a thorough patient history and running tests. This is especially true for general practitioners who are not trained in psychology.
And yet: The average time to an MUS diagnosis for a patient presenting with new symptoms was 4 minutes and 25 seconds—and the median time, which is more representative because it eliminates the effect of outliers, was 1 minute and 47 seconds.
1 minute and 47 seconds. It seems impossibly fast until you see the median time for patients who had presented symptoms at a prior visit: 12 seconds.
The trigger for these decisions varied. Sometimes patients themselves would suggest the symptoms were related to stress. But MUS—universally understood by GPs in the study as synonymous with psychosomatic—was also diagnosed in situations that could easily describe the typical presentation of long COVID in a clinical encounter.
Especially influential was a previous diagnosis of MUS or psychogenic symptoms, which means that once one doctor says it’s anxiety, even if they are wrong, others are more likely to do the same, a phenomenon known as “anchoring bias.”
There is much more in the article than the comparison to ME/CFS. You can read the entire piece here.
The New Republic recently had an excellent piece on this issue. I believe it can be accessed online.
Posted by: anon | March 23, 2021 at 05:24 PM