‘Undiagnosing’ neurological disease: how to do it, and when not to

Abstract

Neurologists often pride themselves on their diagnostic skills (figure 1). Indeed, we often assume that having made a firm diagnosis, the flow of initial treatment and longer-term management will follow almost automatically. But with long-term review of patients, neurologists are perhaps better than most at challenging the so-called ‘established diagnoses’; not infrequently they question a previously assigned diagnostic label, or even find it necessary to remove a diagnosis from a patient. Removing a diagnosis lacks a descriptive verb; euphemisms might include ‘maturation of the diagnosis’, ‘diagnostic refinement’ and so on. We suggest that the more robust term ‘undiagnosis’. Stone et al 1 have discussed the different degrees of diagnostic shift. Here we address specifically the process of dealing with previous diagnostic errors, imparting a new diagnosis and removing a previous one. Figure 1 Undiagnosing sometimes requires the skills of Sherlock Holmes. The process of ‘undiagnosing’ has not been studied in any detail; some might argue that it does not merit detailed study. Yet, the impact of the removal of a long-held diagnosis—not just on the patient, but also on their family, carers and other health professionals—may be substantial. Some might assume that removing an erroneous diagnosis could only be a positive event for a patient, but our experience suggests otherwise. We have witnessed the creation of considerable distress, anger and frustration in individuals who may ha…