Last updated on January 8th, 2024 at 10:06 am

Don’t get me wrong, these diagnostic procedures such as X-ray, MRI, CT Scans and many others were and are major advancements to improving the practice of everyday medical care.  However, no matter how excellent the diagnostic procedure (e.g., an MRI of the brain can show the surgeon exactly where the tumor is located) each of these procedures has limitations and these limitations must be kept in mind by the physicians who employ them in everyday practice.

Obviously by saying this I imply that in my reading of the literature and in my own practice as a clinical psychologist specializing in neurology, also as a patient having taken some of the same diagnostic procedures, I have found that sometimes physicians do not seem to respect that all of these procedures have limitations and one can make major mistakes in their diagnostic interpretations from the procedure.

The following are examples of such diagnostic mistakes that I have encountered  over the years.

1. 1. The 64 year old male patient had a comprehensive neurological assessment with a clinical neurological exam and several diagnostic procedures including a brain MRI and CT Scan.  The assessment found no evidence of brain damage to account for the patient’s symptoms and unfortunately the neurologist made a “back door” diagnosis of psychiatric difficulties;  the patient was referred to a psychiatrist who put the patient on psychiatric drugs.  I saw this patient two years later when he showed no response to psychiatric treatment and actually got worse.  I interviewed the patient and his wife, took a history and performed 5 hours of neuropsychological testing, actually the Halstead-Reitan battery.  From the latter I diagnosed moderately cognitively disabling static brain damage.  From the  Halstead-Reitan findings and an examination of the history suggested the origin was likely to have    been cerebral anoxia from his  earlier heart surgery.  Actually his wife thanked me for coming up with the correct diagnosis.  I assume the patient was tapered off psychiatric medications, which I suspect helped to improve his cognitive functioning to some degree.  In my 20 years of specializing in  neuropsychology and working closely with neurologists, neurosurgeons and other neuroscience professionals I have cautioned these professionals not to make a back door diagnosis (as in the above case) and the dangers involved in going from scan to behavior!  One makes fewer mistakes about brain impairment if one goes from behavior (perhaps 5 hours of neuropsych testing) to the patient’s behavior in the everyday world.
   2. This section bring up the inappropriateness of going from scan or other diagnostic procedure to behavior or the clinical symptom.  A year ago I read a research study of  200 patients with back X-rays. Neuroradiologists, with no other information on the patient other than the back X-ray were told to give their opinion on each scan whether or not the patient had any back pain or other clinical symptoms of back disease?  You guessed it, the radiologists did no better than chance in correctly identifying those with or without clinical symptoms!

In the same vein, the writer in order to determine the source of left leg pain had an X-ray of his back and it revealed a great deal of pathology.  The X-ray showed several bilateral stenoses and arthritis throughout the back.  The back surgeon recommended a series of steroid back injections but he anticipated I would require back surgery.

At the time and now most health insurance companies would not reimburse for back surgery unless the patient went through and failed steroid injections!

I am certainly not an expert in interpreting X-rays of backs; however, to me the scan showed bilateral pathology and why did I have unilateral pain in my left leg and foot! I had my physician order an X-ray of my left hip and lo and behold a left hip replacement took away my left leg pain!

3.   Here is one other example of an error of measurement in medicine and also the field of psychology.  An intelligence test does not give an exact IQ. For example, a very good IQ test gives a subject an IQ of 105 but this test has an error of measurement of 5 points,   which means that the subject’s actual IQ is somewhere within 5 points of the obtained IQ.  You might say how does this relate to a medical diagnosis?

Several years  ago I took statins to lower my cholesterol but after reading the literature on cholesterol’s role in preventing heart attacks and  strokes I quit the statins against my physician’s advice.  Five years later my lab work showed my cholesterol was a few points above  the normal range and I did not take my physician’s advice to go back on a statin.

This past year my cholesterol was well within the average range.  Also, for 20 some years I had high blood pressure and was on one and then 2 BP medications;  I lost about 40 pounds and with the therapy and increased exercise  my blood pressure was near normal.

However, in my 80s I had lost an inch of height and perhaps some bone loss with aging and again against my physician’s advice (she said my weight was normal) I decided  to lose 10 more pounds and not only did I find my BPs in the clearly normal range but my blood pressures remained in the normal range after stopping both medicines.

From the above you might say at my 89 years I am a poster child for healthcare that should be teaching patients how to change their self-injurious behavior.  Since I was trained as a psychologist I knew how to change my behavior for better health.

Earlier in life  I was diagnosed with Type 2 diabetes as well as high blood pressure, was on both medications for many years but I changed my behavior and I am no longer on any prescription medications.  With regard to Type 2 diabetes my A1C is 5.6, which is just within the normal range.

The experts in human behavior, including abnormal behavior, are psychologists and if healthcare expanded the role of psychologists in almost all areas of healthcare the U.S. would have better healthcare at substantially lower cost. However, physicians continue to do what physicians have been trained to do, that is, give the patient a medicine whether the health problem is a disease or one caused by non-organic or psychosocial problems.

Actually physicians know that most of our health problems and diseases are preventable with behavior change but the latter is not within their areas of expertise and unfortunately a pharmaceutical is their first choice of therapy whether appropriate or not.