De-diagnosing disease

I tried to placate an angry man in my clinic the other day but I wasn’t very successful. The problem wasn’t that he had to wait two weeks to get an appointment, it was more profound.

“All I want to know,” said Mr Brown, “is do I or don’t I have a disease?”

A recent blood test suggested a diagnosis of pre-diabetes. Our practice systems had swung into action and Mr Brown was trying to deal with the emotional and practical consequences. My explanation that he didn’t have a disease as such, more that he was at risk of developing one, a kind of “pre-disease,” didn’t seem to help.

Making, or excluding, disease diagnoses is what GPs are trained to do. The underpinning methodology is straightforward, in principle at least; panels of experts develop guidelines which describe diagnostic criteria, based on the best …