Published On March 24, 2023
Diagnosis is a series about the past, present and future of a medical cornerstone. It examines all aspects of diagnosis, how it happens, how it can be shaped by history or human bias, and how a diagnosis can itself affect a patient’s health. In this episode:
In the 2019 movie The Farewell, a Chinese family decides not to tell their elderly relative that she has terminal lung cancer. The movie is based on a true story, and in fact, a 2018 survey in the Shandong Province of China found that 82% of Chinese physicians said they would also withhold a terminal diagnosis from a patient if the family wished it. In the movie, a relative explains the decision: They are only protecting the woman from her own grief, they say, because knowing her diagnosis wouldn’t fix anything. The information might actually make her health worse. It is curious to think of a diagnosis causing damage to health, but some do. And the question is increasingly of interest to physicians. In the United States, some patients claim the “right not to know”, a preference to be spared from the anxiety of knowing about a genetic disease they can’t avoid. Another more common way a diagnosis might cause damage is through so-called overdiagnosis. Scott Podolsky, an internist at Massachusetts General Hospital, wrote in a recent article for the BMJ that overdiagnosis could be defined as “correct diagnoses that match established disease definitions, but which don’t in fact help the patient and may cause harm.”
Dr. Leigh Simmons joins the Proto podcast to talk about damage from diagnosis and how it might be avoided is Dr. Leigh Simmons. Simmons is the medical director of the MGH Health Decision Sciences Center, where she studies ways in which physicians and patients talk about disease.
Stay on the frontiers of medicine
- Diagnosis, Ep. 1: Diagnosis, Case by Case
For a century, carefully selected MGH patient histories have illuminated the art of medicine.
- Diagnosis, Ep. 2: A Brief History of Diagnosis
The route to a diagnosis is straightforward in modern medicine, right? It’s anything but, according to Bedside Rounds host Adam Rodman.
- Diagnosis, Ep. 4: Diagnosis Through the Bias Filter
Research increasingly shows that preconceptions around gender and race can cloud clinical thinking.