This collection is dedicated to the diagnostic moment and its unrivaled influence on encompassment and exclusion in health care. Diagnosis is seen as both an expression and a vehicle of biomedical hegemony, yet it is also a necessary and speculative tool for the identification of and response to suffering in any healing system. Social scientific studies of medicalization and the production of medical knowledge have revealed tremendous controversy within, and factitiousness at the outer parameters of, diagnosable conditions. Yet the ethnographically rich and theoretically complex history of such studies has not yet congealed into a coherent structural critique of the process and broader implications of diagnosis. This volume meets that challenge, directing attention to three distinctive realms of diagnostic conflict: in the role of diagnosis to grant access to care, in processes of medicalization and resistance, and in the transforming and transformative position of diagnosis for 21st-century global health. Smith-Morris’s framework repositions diagnosis as central to critical global health inquiry. The collected authors question specific diagnoses (e.g., Lyme disease, Parkinson's, andropause, psychosis) as well as the structural and epistemological factors behind a disease’s naming and experience.

Mental illness is many things at once: It is a natural phenomenon that is also shaped by society and culture. It is biological but also behavioral and social. Mental illness is a problem of both the brain and the mind, and this ambiguity presents a challenge for those who seek to accurately classify psychiatric disorders. The leading resource we have for doing so is the American Psychiatric Association’s Diagnostic and Statistical Manual, but no edition of the manual has provided a decisive solution, and all have created controversy. In The Diagnostic System, the sociologist Jason Schnittker looks at the multiple actors involved in crafting the DSM and the many interests that the manual hopes to serve. Is the DSM the best tool for defining mental illness? Can we insure against a misleading approach? Schnittker shows that the classification of psychiatric disorders is best understood within the context of a system that involves diverse parties with differing interests. The public wants a better understanding of personal suffering. Mental-health professionals seek reliable and treatable diagnostic categories. Scientists want definitions that correspond as closely as possible to nature. And all parties seek definitive insight into what they regard as the right target. Yet even the best classification system cannot satisfy all of these interests simultaneously. Progress toward an ideal is difficult, and revisions to diagnostic criteria often serve the interests of one group at the expense of another. Schnittker urges us to become comfortable with the socially constructed nature of categorization and accept that a perfect taxonomy of mental-health disorders will remain elusive. Decision making based on evolving though fluid understandings is not a weakness but an adaptive strength of the mental-health profession, even if it is not a solid foundation for scientific discovery or a reassuring framework for patients.

Many published books that comment on the medical model have been written by doctors, who assume that readers have the same knowledge of medicine, or by those who have attempted to discredit and attack the medical practice. Both types of book have tended to present diagnostic categories in medicine as universally scientifically valid examples of clear-cut diseases easily distinguished from each other and from health; with a fixed prognosis; and with a well-understood aetiology leading to disease-reversing treatments. These are contrasted with psychiatric diagnoses and treatments, which are described as unclear and inadequate in comparison. The Medical Model in Mental Health: An Explanation and Evaluation explores the overlap between the usefulness of diagnostic constructs (which enable prognosis and treatment decisions) and the therapeutic effectiveness of psychiatry compared with general medicine. The book explains the medical model and how it applies in mental health, assuming little knowledge or experience of medicine, and defends psychiatry as a medical practice.

In 2013, the American Psychiatric Association published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Often referred to as the “bible” of psychiatry, the manual only classifies mental disorders and does not explain them or guide their treatment. While science should be the basis of any diagnostic system, to date, there is no knowledge on whether most conditions listed in the manual are true diseases. Moreover, in DSM-5 the overall definition of mental disorder is weak, failing to distinguish psychopathology from normality. In spite of all the progress that has been made in neuroscience over the last few decades, the psychiatric community is no closer to understanding the etiology and pathogenesis of mental disorders than it was fifty years ago. In Making the DSM-5, prominent experts delve into the debate about psychiatric nosology and examine the conceptual and pragmatic issues underlying the new manual. While retracing the historic controversy over DSM, considering the political context and economic impact of the manual, and focusing on what was revised or left unchanged in the new edition, this timely volume addresses the main concerns of the future of psychiatry and questions whether the DSM legacy can truly improve the specialty and advance its goals.

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

An exposé on Big Pharma and the American healthcare system’s zeal for excessive medical testing, from a nationally recognized expert More screening doesn’t lead to better health—but can turn healthy people into patients. Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening. Drawing on 25 years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with “abnormal” test results have been drastically lowered just when technological advances have allowed us to see more and more “abnormalities,” many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10% of 2,000 healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers. With genetic and prenatal screening now common, patients are being diagnosed not with disease but with “pre-disease” or for being at “high risk” of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.

Chapter topics include: Clinical Reasoning and Diagnostic Error Theoretical Concepts to Consider in Providing Clinical Reasoning Instruction Developing a Curriculum in Clinical Reasoning Educational Approaches to Common Cognitive Errors General Teaching Techniques Assessment of Clinical Reasoning Faculty Development and Dissemination Lifelong Learning in Clinical Reasoning Remediation of Clinical Reasoning Novel Approaches and Future Directions Teaching Clinical Reasoning: Where do we go from here?