On labels and boundaries
What we call a disease matters. It matters to the person because a diagnosis is a marker: this problem is known, it’s recognised, it’s real (Mengshoel, Sim, Ahlsen &Madden, 2017). It matters to the clinician, particularly medical practitioners, but also those clinicians working within a largely “disease-oriented” framework (for example, physiotherapists, osteopaths) (Haskins, Osmotherly, Rivett, 2015; Kennedy, 2017). It matters also to insurance companies, or funding providers – who is in, and who is out. The diagnostic label itself hides a great many assumptions. The ways in which diagnostic labels are grouped reflects assumptions about underlying similarities (and distinctions) between groups of symptoms. Added to this complex situation is uncertainty in how the person presents: are they a “typical” presentation? Who decides what is ‘typical’? Think of the classic signs of chest pain signifying myocardial infarct – but this applies to males, and less so to females. Women are less likely to be resuscitated after chest pain, and also less likely to be transported to the Emergency Department using lights and sirens (Lewis, Zeger, Li, Mann, Newgard, Haynes et al, 2019). It is the physician’s quest for certainty and the patient’s illusion of certainty, however, that leads to many of the current decision-making techniques in the practice of medicine. Evidenced-based medicine seeks to provide informa...
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