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Spurious syndromes: we create disease by giving every illness a name

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1828 (Published 04 March 2014) Cite this as: BMJ 2014;348:g1828
  1. Caroline Dover, core surgical trainee 1 doctor, trauma and orthopaedics, Oswestry/Shrewsbury School of Surgery, Royal Shrewsbury Hospital, Shrewsbury, Shropshire SY3 8XQ, UK

It might be superficially attractive for patients—and doctors—to give medically unexplained symptoms spurious labels, but they may not be helpful in the long run, says Caroline Dover

Trochanteric bursitis is a common diagnosis for patients who present with non-specific pain and tenderness over the greater trochanter. In 1923 Stegemann attributed such pain to inflammation in the trochanteric bursa.1 2 3 Today, because of a lack of convincing evidence of inflammation or infection in the bursa, the term “greater trochanteric pain syndrome” (GTPS) has been used.4 5 6 However, in clinical practice, trochanteric bursitis still holds sway.

These are umbrella terms for pain that defies accurate diagnosis and are usually presented as tentative diagnoses by clinicians who understandably want to explain the symptoms to anxious patients, who in turn understandably want an explanation for their disability.

Even uncertain diagnoses have advantages: they provide patients with explanations and preclude the need for further investigation. They offer a form of closure, and because the cause of the trochanteric pain is almost certainly benign and usually self limiting, the risk of harm to the patient from these sham diagnoses is likely to be small.

Pain …

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