Naming vs diagnosing a condition can result in varying responses from a patient and may also influence social stigmas and how a condition is treated. In the AMA Code of Medical Ethics, guidance is provided for physicians in conversing with patients regarding their health issues, particularly as it relates to approaching sensitive diagnoses like obesity or psychosomatic disorders. This is according to a paper published in the AMA Journal of Ethics.
Scott J. Schweikart, JD, MBE, presented the case of a patient who visits the dermatologist with pruritis, but who suspects eggs are hatching from her skin after a bed bug infestation. The dermatologist finds keratin in the presented “egg” samples and believes the patient has a psychosomatic disorder. The physician refers to the AMA Code to determine the appropriate course of action for naming the condition without sounding dismissive of the patient’s concerns. According to the Code‘s Opinion 1.1.3, “The health and well-being of patients depends on a collaborative effort between patient and physician in a mutually respectful alliance.”
Another case is that of a 14-year-old girl with obesity based on body mass index values who agrees with the physician-made suggestion of bariatric surgery, but the surgery is flatly refused by the girl’s mother. According to the “Pediatric Decision Making” section in the AMA Code, treatment decisions “should be based on the child’s best interest, which is determined by weighing many factors, including effectiveness of appropriate medical therapies and the needs and interests of the patient and the family as the source of support and care for the patient.” Based on this statement, the physician should engage in a serious discussion with the mother and daughter about whether this treatment option is necessary, particularly if lifestyle interventions have been inadequate.
According to Mr Schweikart, these cases “suggest ways in which the AMA Code might be interpreted and applied in scenarios in which labeling a disease can affect not only a diagnosis, but also clinical encounters and thus the quality of patient-physician relationships.”
Schweikart SJ. AMA code of medical ethics’ opinions related to a physician’s power to name. AMA J Ethics. 2018;20(12):E1139-E1142.