A friend of mine, who had a long term mild condition, recently went looking for a diagnosis to get some sort of advice. He wanted to know more about his condition and possibly get some information about how to handle the unpleasant aspects of the condition. Inevitably he found someone he thought was an expert diagnostician, and she gave him one. The diagnosis he received was laughable, and if I hadn’t intervened his health could have been in jeopardy. What did she say to him that was so off the mark, and why do we have to be so careful when we have our medical issues tested?
The Truth about Most Diagnoses
There’s a dirty secret about diagnosis that many doctors aren’t even aware of. That secret is that confirmation bias is an incredibly easy trap to fall into. It’s all the easier if your patient give you information up front. This isn’t just because it’s easy to pretend you’re too learned for confirmation bias, or to not know about it, but because the best way to be seen as a good doctor (and therapist especially) is to confirm what the other person says and believes. After all, we’re more likely to accept things as true if we already somewhat believe them. The problem is, sometimes the best advice is to confirm what the other person believes to be true. People that come looking for a diagnosis of their toothache, or their chronic migraines, often have some idea what’s wrong. Often those internet research diagnoses are valid and correct, and they’re just looking for an M.D. to confirm what they think is true. The diagnosis will often confirm this. In the case of methods like MRIs, this interpretation being appropriate will usually be very clear in the machine’s output. Expert diagnosticians can therefor still ignore any information they would have gotten beforehand.
Confirmation bias can also exist due to what the doctor believes. If they believe certain things about a specific condition, you’re probably going to hear that opinion in the end. My friend’s diagnosis was one such case. The psychiatrist he found to test him clearly believed that Asperger’s was just incel delusions, and that he must have OCD. After she came up with that opinion, she claimed his father had shared a long list of the son’s OCD symptoms with her, a clear case of confirmation bias, especially once you recognize how illogical her claim was. We already know that vaccination doesn’t lead to OCD. The idea that she didn’t meet his father, and then communicated with him is also very illogical.
To the doctor’s credit, I don’t think that she intended to lead my friend astray. She was just giving a diagnosis to the best of her ability. However, her interpretation wasn’t guarded against her own biases and could have caused some real damage. The ability to remove oneself from that confirmation bias (as well as other biases) in a clinical setting, even when you know upfront information, is one of the differences between an expert and a novice (in that the novice will have fewer preconceptions and obsolete understandings). If you don’t account for this it’s easy to give bad advice about workplace limitations, about viruses, and especially about mental health.
When you ask for a diagnosis that you intend to take at face value, you are giving the doctor an immense amount of power over your personal life. You are very likely to take their words to heart if you see them as an expert that is simply interpreting information from some tests. My friend’s case happens to be a great example. Before I really sat down with him and explained why the diagnosis he got was flawed, he was taking it as face. He hadn’t fully examined those claims, because he trusted the practice that he had gone to. He fully believed his autism was actually OCD, and was going to change up his approach to account for that.
What happens when a doctor who doesn’t like the adult autism community or thinks autism doesn’t exist tells my friend that his condition is narcissism, or schizophrenia? With the clatter of a keyboard that condition could be combated with high doses of antipsychotics, the worst possible outcome. Another friend ended up in the opposite situation when she was denied a diagnosis and medication for an obvious condition due to the doctor’s desire to bring her back to political orthodoxy after a stray comment tangent to the disease in question. While that doctor eventually sent her to somebody else to write the prescription, it does show how a socially manipulative “expert” can interfere with a mentally stable patient’s treatment, inevitably causing the patient’s condition to deteriorate. She even made a profit off her delaying tactic.
The treatment process is about understanding. Your quest is to try and figure out what makes your body tick, and to grow as close to finding a cure as you possible can. There is no diagnosis, no advice, and no secret occult ritual that can create a shortcut in that process. Hungering for that understanding is a natural feeling, because the more you know and understand about your condition, the better you’ll be able to determine a good treatment plan. It’s like gradually using bigger containers to bail out a sinking ship. There is no shortcut to true understanding, because a true understanding of your body isn’t just knowledge. It’s not even just a feeling either. It’s being healthy. That is the quest of every person who starts to feel ill, and there is no advice or diagnosis that can offer a shortcut on that path.
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Clearly the biggest issue with the medical industry is people taking seriously the opinions of doctors who don’t agree with me. I hope you’ve come to see this too.
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