August 2020 Edition. Volume XX

Walter Mitty 600p

In the 1947 movie “The Secret Life of Walter Mitty”, Danny Kaye daydreams that he is a world famous surgeon in the process of making an incision, when he suddenly announces to the collective operative team that “coreopsis” has set in and all involved then recoil in horror. The sound bit “coreopsis” could not be a better means of conveying the impression of an terrible affliction being discovered.  Coreopsis, is, however, actually the name of a flowering houseplant.

Coryopsis 150p

There was a time when medical diagnoses were characterized by a wealth of similarly nonsensical and non-specific diagnoses, of which such terms such as: “inanition”, “dropsy”, and “imbalance of the body humors” were not uncommonly used to state a definitive diagnosis.

Remarkably, it now appears that we are once again harkening back to the age of nonsensical medical diagnoses.  As a neurosurgical spine specialist the editor has observed, with a rising sense of alarm, imaging studies of the spine being read by radiologists as primarily demonstrating “spondylosis” (Spondylo- vertebrae; -osis condition of)  as the initial diagnosis.

When dictating radiologists have been queried about this issue their consistent answer has been that the diagnosis of “spondylosis” was being used by their organizations only because this had been found to be the magic key to unlocking reimbursement whereas other, more specific diagnoses, were not being reimbursed.

It is evident that economics is driving this nonsense.  Will the next step be describing lesions of the brain as being “neuralosis”?  Or, how about describing a cause of death as being due to “corpuslosis” (condition of the body)?

The computer techies talk about “garbage in, garbage out.”  It does not take very much imagination to see that some of the fallout from the likes of  coreopsis as a medical diagnosis will be the increased “garbaging” of future health care statistics and the decreasing reliability of healthcare related incidence and prevalence studies.

One of today’s other unfortunate realities is that treating physicians, in the attempt to place the best interests of their patients first, will sometimes list an incorrect diagnosis as part of a well-intentioned effort to have the treatment approved and equally as important, to have such paid for by the patient’s insurance.

All of this behavior demeans and undercuts the science and practice, as well as the ethics of patient care. While there may not be an easy answer to this dilemma the first productive step needs to be the identification of such nonsense.

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