April 8, 2016

A new diagnosis for radiologists. Part 1 of 2.

This is part 1 of a 2-part series. Read part 2.

Not long after I altered course to pursue a medical career in radiology rather than psych, the latter had something of a field day in handing out diagnoses of Attention Deficit Disorder (ADD) to just about every prepubertal comer. Then, seemingly recognizing its error, proceeded to start overdiagnosing it in adults as well.

Best as I can tell from my no-longer-actively-clinical psych perspective, it seems they’ve subsequently reined themselves in a bit, at least upon a cursory review of the DSM-V criteria. Still, ADD is far from a diagnostic rarity, and I’ve occasionally wondered whether an opposite number might exist.

Medicine isn’t often at a loss for declaring things abnormal, after all. If you take just about anything that can be quantified, and move a couple standard-deviations from the mean, it’s probably been called abnormal, or at least correlated with abnormalities. Since this tends to go in both directions, an awful lot of conditions come in multiples of two: Too much of something (hyper), or too little of it (hypo).

So, if Attention Deficit is genuine pathology, might we not consider Attention Excess a disorder too? Or is attention, like IQ, a rare instance in which one cannot have too much of a good thing?[[{"type":"media","view_mode":"media_crop","fid":"47546","attributes":{"alt":"Diagnosing radiologist","class":"media-image media-image-right","id":"media_crop_2070629203828","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5606","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 120px; width: 180px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Masha Tace/","typeof":"foaf:Image"}}]]

It would seem to be so, for those of us tasked with churning through endlessly-repopulating worklists despite a gazillion potential distractors. Indeed, if I were any less on-task than I am, I might find my typical 10-hour workday an interminable ordeal. My own personal Purgatory. As opposed to reaching quitting time and feeling like maybe I can grind out another few cases before feeding myself.

Still, I had a look through the DSM-V criteria for diagnosing ADD, and considered whether their extreme opposites might qualify as disorder-like, or at least maladaptive. I think I’m on to something, here…tune in next week for more.