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1 Preventing diagnostic disorientation is the key to preventing overdiagnosis
  1. Daniel Sager
  1. Providence Hood River Arthritis Center, Hood River, Oregon, USA, Oregon Health and Science University, Portland, Oregon, USA


Objectives Providing patients and students with a simplified orientation to the cognitive framework clinicians use to make diagnoses is central to preventing overdiagnosis. Emphasizing this framework helps avoid diagnostic disorientation, a common phenomenon that results in waste of time, overuse of technical resources, and diagnostic limbo. Rheumatic diagnoses, with nuanced or overlapping clinical features, are often considered difficult to make. A diagnostic strategy that begins with a quickly visualized ‘choice framework’, functioning like a menu or field guide to pattern recognition, orients the student, clinician, and patient, thereby limiting the risk of over-testing and other drivers of overdiagnosis.

Method A novel clinical decision support method (, adapted for bedside use as a mobile health tool, mimics how experienced rheumatologists organize their diagnostic reasoning. It serves to quickly bring patients, students, and primary care clinicians to a level playing field for interacting and choosing effective diagnostic strategies. As a patient-centered care tool, it demystifies the diagnostic process.

Rheumatologic examples will be used to highlight the role that orientation plays in preventing overdiagnosis in many other healthcare settings:

  1. Showing how diagnostic orientation can be a critical first step in avoiding the disarray of over–testing and other overuse of resources;

  2. Discussing patient case histories to exemplify the several main causes of diagnostic limbo and how limbo, as a type of stressor, amplifies many of the processes underlying overdiagnosis;

  3. Comparing the processes of disease recognition, disease naming, and diagnostic reasoning in the medical setting to how field guides are effectively used in nature to more readily and accurately identify species.


  1. Sager D. A field guide to rheumatology. Afr J Rheumatol 2016;3(1):1–2.

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