What is diagnostic overshadowing?

Diagnostic overshadowing is a significant issue in the healthcare sector, often leading to serious consequences for patients. The term is mainly used in medical settings but in recent years, recognition and awareness of diagnostic overshadowing has increased in wider society.

What is meant by diagnostic overshadowing?

According to the National Institute for Health and Care Excellence (NICE), diagnostic overshadowing “occurs when the symptoms of physical ill health are mistakenly either attributed to a mental health or behavioural problem or considered inherent to the person’s learning disability or autism diagnosis.”

In simpler terms, diagnostic overshadowing is when a medical professional assumes that someone’s symptoms are related to their disability or mental health condition, and as a result, does not explore the cause of these symptoms.

For example, a person with a learning disability may complain of pain, but the healthcare provider may dismiss it as part of their disability, failing to investigate the pain properly. Similarly, those with mental health conditions may have their physical symptoms (e.g. prolonged headaches or a fast heart rate) attributed to anxiety or depression without thorough exploration of other potential causes.

What are the consequences of diagnostic overshadowing?

Unfortunately, diagnostic overshadowing can result in delayed diagnosis, misdiagnosis, or even failure to provide necessary treatment. While healthcare professionals may have the best intentions, the failure to recognise and investigate a new condition can cause significant harm. Left untreated, a medical issue could worsen, lead to unnecessary suffering, or even become life-threatening.

Our clinical negligence solicitors are all too aware of the consequences that diagnostic overshadowing can have on patients and their loved ones. We recently acted in a case involving diagnostic overshadowing for a client who had been admitted to hospital following a period of poor mental health, during which her oxygen levels were repeatedly found to be abnormally low. It might be that the healthcare professionals attributed the patient’s abnormal oxygen levels to anxiety or hyperventilation associated with their mental health condition. Rather than considering an underlying physical issue, they may have assumed that the low oxygen levels were a psychosomatic response or a temporary side effect of the patient’s psychiatric symptoms, such as agitation or panic.

Consequently, they missed the need for further investigation, believing the symptoms were part of the mental health episode, rather than exploring the possibility of a serious physical condition like pulmonary arteriovenous malformation (PAVM). This delay had a profound impact on their life and ability to work and, tragically, resulted in a series of strokes. Read our client story in full here.

How can diagnostic overshadowing be avoided?

There are various guidelines set by the NHS and NICE which include useful links for healthcare professionals, such as NCAPC (Non-Communicating Adults Pain Checklist) which is an 18-item list to help medics assess chronic pain in non-communicating adults, and information about the Mental Capacity Act.

Despite healthcare professionals having some level of training in assessing patients with mental health conditions or physical or mental disabilities, this is not always up to date and can be compromised when working in high-pressure environments.

The latest guidelines also offer reminders about the importance of listening to parents and carers (who often act as advocates for the patient) and looking at healthcare passports. There is also an emphasis on understanding behavioural responses to illness, pain and discomfort and asking questions about what is ‘normal’ for that person. Healthcare professionals are also reminded and encouraged to ask for a second opinion or specialist support; for example, many hospitals have learning disability teams.

From a patient’s perspective, having a friend or family member (who knows you and your condition/s well) present at appointments or consultations to act as an advocate can help avoid the risk of diagnostic overshadowing. However, the onus is on medical professionals to carry out thorough and appropriate assessments, and for healthcare providers to provide up-to-date training to support this.

Further information

If you or a loved one have been affected by a delayed or missed diagnosis as a result of diagnostic overshadowing, our medical negligence solicitors are here to help.

Our expert solicitors may be able to help you claim compensation to fund treatment, rehabilitation and specialist equipment. To speak to a member of our team, call 0117 325 2929 or fill out our online enquiry form.