Uncertain diagnostic language affects further studies, endoscopies, and repeat consultations for patients with functional gastrointestinal disorders

Abstract

Background & Aims: Although guidelines state that functional gastrointestinal disorders (FGID) can be diagnosed with minimal investigation, consultations and investigations still have high costs. We investigated whether these are due to specific behaviors of specialist clinicians, examining differences in clinician approaches to organic gastrointestinal diseases vs FGIDs. Methods: We performed a retrospective review of 207 outpatient department letters written from the gastroenterology unit at a tertiary hospital following patient consultations from 2008 through 2011. We collected data from diagnostic letters and case notes relating to patients with organic (n=108) or functional GI disorders (n=119). We analyzed the content of each letter using content analysis, and reviewed case files to determine which investigations were subsequently performed. Our primary outcome was the type of diagnostic language used, and other aspects of the clinical approach. Results: We found gastroenterologists to use 2 distinct types of language: clear vs qualified, consistent with their level of certainty (or lack thereof). For example, "the patient is diagnosed with…." vs "it is possible that this patient might have….''. Qualified diagnostic language was used in a significantly higher proportion of letters about patients with FGID (63%) than organic gastrointestinal diseases (13%) (P<.001). In addition, a higher proportion of patients with FGID underwent endoscopic evaluation than of patients with organic gastrointestinal diseases (79% vs 63%; P<.05). Conclusions: In an analyses of diagnoses of patients with FGIDs vs organic disorders, we found that gastroenterologists use more qualified (uncertain) language in diagnosing patients with FGID. This may contribute to patient discard of diagnoses and lead to additional, unwarranted, endoscopic investigations.