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.
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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.
Specific diagnoses
Many alternative medicine diagnoses, such as candida overgrowth and multiple chemical sensitivities, are considered trashcan diagnoses by medical personnel.
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. It is probable that the stress response and emotional dysregulation contributes to the patient presentation. A list of common wastebasket diagnoses encountered in Family Practice:
- Adult ADD
- Chronic Fatigue Syndrome
- Fibromyalgia
- Subclinical Hypothyroidism
- Seronegative Rheumatoid Arthritis
- Irritable Bowel Syndrome
- Chronic pain syndromes
- Interstitial Cystitis
Diagnoses which include a wide variety of complaints and symptoms are particularly prone to being used as trashcan diagnoses, as well as diseases with variable presentations. For example, fibromyalgia has been used as a trashcan diagnosis to describe chronic pain. Costochondritis, gastroesophageal reflux, and chronic fatigue syndrome are all commonly used as trashcan diagnoses. Bronchitis may be used as a trashcan diagnosis to label sick children. 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.
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.
History
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.
Management
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.