A wastebasket diagnosis or trashcan diagnosis is a vague diagnosis given to a patient or to medical records department for essentially non-medical reasons. It may be given when the patient has an obvious but unidentifiable medical problem, when a doctor wants to reassure an anxious patient about the doctor's belief in the existence of reported symptoms, when a patient pressures a doctor for a label, or when a doctor wants to facilitate bureaucratic approval of treatment.
The term may also be used pejoratively to describe disputed medical conditions. In this sense, the term implies that the condition has not been properly classified. It can carry a connotation that the prognosis of individuals with the condition are more heterogeneous than would be associated with a more precisely defined clinical entry. As diagnostic tools improve, it is possible for these kinds of wastebasket diagnoses to be properly defined and reclassified as clinical diagnoses. Wastebasket diagnoses are often made by medical specialists, and referred back to primary care physicians for long term management. In one study, more than three quarters of primary care visits were found to have no organic or physical cause.[dubious ] It is probable that the stress response and emotional dysregulation contributes to the patient presentation.
Common wastebasket diagnoses include:
- Chronic fatigue syndrome (when applied to undiagnosed fatigue)
- Fibromyalgia (when applied to undiagnosed pain)
- Subclinical hypothyroidism
- Seronegative rheumatoid arthritis
- Irritable bowel syndrome
- Chronic pain syndromes
- Interstitial cystitis ("bladder pain syndrome")
- Costochondritis (when applied to undiagnosed chest pain)
- Gastroesophageal reflux (when applied to undiagnosed chest pain)
Reactive hypoglycemia has been used as a trashcan diagnosis for people who complain about normal physiological reactions to being hungry. In these cases, the labels are offered when nothing more serious can be identified. Bronchitis may be used as a trashcan diagnosis to label sick children.
Some diagnoses are being used as trashcan diagnoses in response to unintentional incentives. For example, government-run schools in the United States get additional funding for providing services to students with autism spectrum disorders, so some children with atypical behavior patterns are labeled as having ASD so the school can more easily obtain funding for special education services.
Fake diagnoses are not a modern invention. Medicine around the world has a long history of using and abusing the concept of trashcan diagnoses, from "rectifying the humors" to marthambles to neurasthenia to garbled Latin-sounding names which were made up to impress the patient's family.
The medical community is often split on the best approach to managing a wastebasket diagnosis. The biggest challenge for a physician is maintaining their interest and desire to see the patient through their illness. Anti-depressants and cognitive therapies are commonly employed, speaking to the probable emotional basis that underpins these diagnoses.
- Diagnosis of exclusion, the diagnosis given to a patient when all other plausible options have been ruled out
- "trashcan diagnosis". Retrieved 2008-03-29.
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For example, many patients with chest pain carry a diagnosis of costochondritis (inflammation of the chest wall bones) or gastroesophageal reflux (regurgitation of stomach acid into the esophagus). These are real conditions. But they tend to generate little interest from many physicians, who may refer to them as 'wastebasket diagnoses,' offered when nothing more serious has turned up. The frustration of patients who believe that the medical profession takes these types of ailments too lightly has led groups of them to form alliances to publicize their illnesses. Foremost among them are fibromyalgia, a syndrome involving muscular and other pains, and chronic fatigue syndrome...
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The recent explosion of cases appears to be mostly caused by a surge in special education services for autistic children, and by a corresponding shift in what doctors call autism.
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