The Road to Diagnosis

Getting the right diagnosis can be life-changing. It can mean the end of pain and the beginning of answers; it can mean treatment, a cure — or at least a path forward; or it can just mean validation for everything a patient has been through.

Diagnosis is at the heart of medicine — and yet it seems like it often goes wrong. Patients sometimes wait months or even years for answers. They suffer through endless tests, ineffective treatments, overlooked issues — or straight-up misdiagnoses. And for some patients, answers never come at all.

On today’s episode, we travel down the long and winding road to diagnosis. We get an inside look at how diagnoses are made, what they mean to and for patients, and the challenges doctors face in getting them right.

We hear about the dangers of too much testing, the debate over “gaming disorder,” and a medical mystery from The New York Times columnist Lisa Sanders.

Also heard on this week’s episode:

• Primary care physician Neda Frayha discusses the challenges of making the right diagnosis, the fear of getting it wrong, why it sometimes takes so long to get answers, and why it’s okay to cry when you are communicating a tough diagnosis to a patient. We also hear from another primary care physician Jay-Sheree Allen, about the importance of taking a good patient history, and getting comfortable with the unknown.
• In a perfect world, medical tests help narrow down the possibilities, leading to a diagnosis. But sometimes, the opposite happens — a suspicious finding leads to more tests, which leads to a specialist visit, which leads to scans or x-rays, and on it goes. This is what experts call “a cascade of care” — seemingly endless diagnostics that are time-consuming, anxiety-provoking, not to mention expensive. In this story from the health policy podcast Tradeoffs, Dan Gorenstein explores what’s behind cascading care, and what it would take to stop it.
• The New York Times “Diagnosis” columnist and physician Lisa Sanders shares one of her latest mysteries — and explains why confirmation bias can point health care providers in the wrong direction.
• The World Health Organization recently added a controversial new illness to its comprehensive manual of diseases: gaming disorder. Reporter Alan Yu looks into why gaming disorder has sparked so much debate, and whether this new diagnosis is actually changing the way patients are treated.