Iatrogenic Chronification as a Result of Pseudo Diagnosis
Among other issues the guideline also mentions iatrogenic chronification factors and unfavorable physician behavior. In my daily job as a physician working for a large private health insurance company I have, for years, noticed another diagnostic/therapeutic approach to somatoform bodily complaints, which contributes to their iatrogenic chronification.
What I am referring to is the fact that somatoform, functional, and non-specific bodily complaints are labeled with pseudo diagnoses in the context of alternative medical treatment.
I would like to explain what I mean by using the pseudo diagnosis “intestinal mycosis/candidiasis” as an example. Practitioners of alternative medicine make this pseudo-diagnosis with great regularity even if Candida albicans is found in a patient's stool specimens only sporadically. As is common knowledge, Candida can be found in the intestine of 50–70% of healthy patients in whom no disorder that requires treatment is present. In spite of this, the pseudo diagnosis candidiasis is used regularly to explain all kinds of existing bodily complaints, such as fatigue, constipation, meteorism, urinary tract infections, circulatory complaints, myalgia, and pain in different locations.
Treatment is often administered by means of infusions of vitamins and trace elements, through colon hydrotherapy, or administration of antimycotic drugs.
All this equals unfavorable physician behavior and contributes to iatrogenic chronification of the complaint. In the best case scenario, such treatment is useless, but if colon hydrotherapy, or antimycotic medications are used, serious adverse effects may ensue.
In any case, such a pseudo diagnosis and therapy distracts from effective and medically necessary psychotherapeutic treatment and ultimately delays or even prevents such treatment.
Dr. med. Rainer Hakimi
Conflict of interest statement
The author is lead insurance company physician of Hallesche Krankenversicherung (a private health insurance company).
|1.||Schaefert R, Hausteiner-Wiehle C, Häuser W, Ronel J, Herrmann M, Henningsen P: Clinical Practice Guideline: Non-specific, functional and somatoform bodily complaints. Dtsch Arztebl Int 2012; 109(47): 803–13 VOLLTEXT|