Deliberate Misdiagnosis

The Art of Diagnosing: The Implications of Deliberate Misdiagnosis The misdiagnosis of a patient is an occurrence that happens quite frequently within clinical practice for various reasons. Many times these misdiagnoses are due to unintentional errors. However, there are times when practitioners intentionally misdiagnosis patients (Kirk and Kutchins, 1988). Deliberate acts of misdiagnosis exist that are universally viewed as being unethical such as blatant use of fraud or abuse. However, there are forms of deliberate misdiagnosis that are viewed less objectively, and are often justified as being in the best interest of the client. The inclination to justify the use of misdiagnosis is often intensified for clinicians due to internal and external

However, conflict can arise when it is discovered that a client meets the criteria for a diagnosis that could negatively affect the client because of the stigma attached to that particular diagnosis. Clinicians often feel personal internal pressure as they grapple with diagnosing someone who they believe will suffer from more from being accurately diagnosed than he or she will, if given a less severe diagnosis. Clinicians often want to avoid the negative effects that the labeling of a severe diagnosis will have on a client’s self-esteem (1988). Along with internal pressure, external pressure also weighs heavily on clinicians. In order to adhere to external pressure brought on by agencies seeking and insurance companies seeking reimbursement, clinicians may be pressured to over-diagnosis patients. Over-diagnosis mainly stems from the desire to attain economic benefits rather than therapeutic benefits. Currently, both public and private payers base reimbursement for services off of clinical diagnosis. The more severe the disorder, the more reimbursement the insurance payers are willing to provide. The direct result of this payer system has led to an increase in clinical over-diagnosis (1988). According to the clinical study conducted by Kirk and Kutchins, eighty-percent of the clinical social workers that were surveyed, indicated that third party requirements for reimbursement

Yet, for a patient, under or over diagnosis becomes problematic when it results in inappropriate treatment based on diagnosis. Clients, however are not the only ones affected by misdiagnosis. As Kirk and Kutchins conferred, “by focusing only on the presumed benefits to clients, clinicians avoid confronting the broad ethical implications that emanate from the practice of misdiagnosis.” (P. 232. 1988). These implications have ethical and practical consequences that are not limited to clients only, but also directly and indirectly affect others, such as clinicians, professional organizations, policymakers, third party payers, taxpayers and the government (1988). If clinicians, for instance, become aware of the prevalence of misdiagnosis within their own field, they may accept these patterns as normative and become more willing to engage in manipulating diagnoses as well. This continuation of corruption can spread into the entire profession and thus damage the integrity of the profession as a whole