23/07/2025
One day I will write a book titled:
"The Closing of the Doctors' Minds: How the Misuse of 'Classification Criteria' as 'Diagnostic Criteria' in Clinical Practice Contributed to the Suffering of Thousands of Patients."
In clinical practice, we've witnessed a growing misuse of classification criteria — tools originally designed to create homogenous study populations — as if they were meant for diagnosis. This misunderstanding has closed many physicians’ minds, leading to delayed diagnoses and unnecessary suffering for countless patients.
One of my mentors in Wisconsin used to say something so simple, yet so wise:
"If it looks like a duck, swims like a duck, and quacks like a duck, then it's probably a freaking duck."
Yet, somehow, many of us have forgotten this basic clinical intuition.
Just recently, I saw a patient with recurrent neurological symptoms and progressive disability. I told him, "I'm not a neurologist, but you strike me as a textbook case of MS (Multiple Sclerosis)." He nodded — and said that two neurologists had already told him the same.
But both refused to make the diagnosis.
Why?
Because he didn’t meet the criteria.
That is insane.
We see this all the time in rheumatology, too — patients suffering for years because they don't "fit the criteria," even when the clinical picture is obvious.
Let’s be clear: classification criteria were never meant for clinical diagnosis. They were developed to ensure consistent inclusion in research studies. Using them as diagnostic tools in practice leads to both under-diagnosis and over-diagnosis.
It’s time to stop the madness.
We must reclaim clinical reasoning, trust our judgment, and remember that patients don’t always read the criteria before they show up in our clinics.
