Diagnostic errors in emergency room medicine: physical illness in patients labeled "psychiatric" and vice versa

Patients coming to general hospital emergency rooms often present mixed physical and psychological problems. An unfortunate tendency of physicians caring for these patients to "label" them as either "organic" or "psychiatric," based on initial impressions, may lead to inadequate diagnosis and improper treatment. Four case examples are discussed, in which diagnostic errors resulted either from ignoring psychological and social factors, or by focusing on emotional factors to the exclusion of organic disease. The provision of quality medical care in a hospital emergency room requires that attention be directed coordinately to both physical and emotional factors in each patient's illness.