Making an Accurate Diagnosis in One Brief Visit: Is it Possible?

Reader’s Question

My question is whether it’s possible or appropriate for a counselor to make a diagnosis in just one, brief visit? The visit lasted less than an hour. Also, the visit was during a time when I was undergoing a very stressful situation. Is it even possible for a counselor to assess an individual’s normal mental state during a uniquely stressful time or make an accurate diagnosis in such a brief encounter? Should a client be observed on more than one occasion, such as when he is not in the middle of the (temporary) stressful situation? Do you think it’s wise to get a second opinion?

Psychologist’s Reply

Making an accurate diagnosis in a brief time period and with limited background information is always risky business. For a variety of reasons, however, professionals are increasingly obliged to make diagnostic decisions in a timely manner. Because so many factors can influence the symptom picture at any given moment (e.g., situational stressors, the anxiety associated with seeing a counselor, etc.) many professionals render a “provisional” diagnosis at first and then attempt to solidify a more accurate diagnosis over an additional time frame.

Ideally, psychologists make diagnoses based on a comprehensive review of all available information and collateral data, including appropriate psychological testing when indicated. However, the policies of managed care entities and insurance companies have increased the pressure on professionals to make diagnoses on the basis of interviews alone.

Now, in fairness, it’s also not uncommon for an individual who is not happy about a diagnosis to raise concern about the methods used to make it, despite the fact that there was ample objective evidence available to make a valid diagnosis. It’s also possible for a clinician to have so much reliable, objective, collateral information in advance of the client’s first visit that a diagnosis can be made in rather short order. But generally speaking, it is a rare situation in which the symptoms presented by a client are so clearly definitive that a perfectly accurate diagnosis can be upon only brief initial examination. Besides, many times certain conditions can very closely “mimic” other conditions (e.g., like when a non-disclosing substance abuser who has recently ingested a powerful mood-altering drug appears “manic”, etc.). So, for the most part, most clinicians don’t make firm diagnoses based on limited first impressions.

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As the consumer of services, you have every right not only to question the accuracy of any diagnosis but also to seek a second opinion. The questions you raise are issues that all areas of health care are dealing with these days. And, of course, it’s hard if not impossible to get accurate treatment (or the accurate disposition of a case) if the diagnosis is not accurate in the first place. So, in the end the decision is yours as to whether it’s in your best interest to be evaluated by another professional.

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