Missed physical diagnosis: conceptual and moral comments on the psychiatrist-patient relationship

Diagnosis is an important element in the therapeutic alliance. It informs treatment and management decisions in the interests of the patient. The relative and discretionary factors in diagnosis are prominent in psychiatry. The problematic nature of psychiatric diagnoses and the difficulty in demarcating physical from psychic disorders suggests an approach to patients with psychiatric symptoms that is alert to possible somatic causes. The well-being of the patient is primary in the therapeutic exchange. Thus, the moral principle to "do no harm" prevails. The potential costs to patients from missed physical diagnosis counsels an open attitude by psychiatrists in the diagnostic process. There are moral, scientific, and professional reasons to support this approach. Ultimately, the good of the patient and the good of the profession require it.