BACKGROUND Non-organic lesions or diseases of unknown origin are sometimes misdiagnosed as "psychogenic" disorders or "psychosomatic" diseases. For the quality of life and safety of patients, recent attention has focused on diagnostic error. The aim of this study was to clarify the factors that affected misdiagnoses in psychosomatic medicine by examining typical cases and to explore strategies that reduce diagnostic errors. CASE PRESENTATION The study period was from January 2001 to August 2017. The data of patients who had visited the Department of Psychosomatic Medicine, Kindai University Hospital and its branches, Sakai Hospital and Nihonbashi Clinic, were collected. All patients were aged 16 years or over. Multiple factors, such as age, sex, presenting symptoms, initial diagnosis, final diagnosis, sources of re-diagnosis and types of diagnostic errors were retrospectively analyzed from the medical charts of 20 patients. Among them, four typical cases can be described as follows. Case 1; a 79-year-old woman, initially diagnosed with psychogenic vomiting due to depression that was changed to gastric torsion as the final diagnosis. Case 2; a 24-year-old man, diagnosed with an eating disorder that was later changed to esophageal achalasia. Case 10; a 60-year-old woman's diagnosis changed from conversion disorder to localized muscle atrophy. Case 19; a 68-year-old man, appetite loss from depression due to cancer changed to secondary adrenal insufficiency, isolated ACTH deficiency (IAD). CONCLUSION This study showed that multiple factors related to misdiagnoses were combined and had a mutual influence. However, they can be summarized into two important clinical observations, diagnostic system-related problems and provider issues. Provider issues contain mainly cognitive biases such as Anchoring, Availability, Confirmation bias, Delayed diagnosis, and Representativeness. In order to avoid diagnostic errors, both a diagnostic system approach and the reduction of cognitive biases are needed. Psychosomatic medicine doctors should pay more attention to physical symptoms and systemic examination and can play an important role in accepting a perception of patients based on a good, non prejudicial patient/physician relationship.

中文翻译：

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避免心身医学中的诊断错误：案例系列研究。

背景技术未知来源的非器质性损伤或疾病有时被误诊为“心因性”疾病或“心身”疾病。为了患者的生活质量和安全，最近的注意力集中在诊断错误上。本研究的目的是通过检查典型病例来阐明影响心身医学误诊的因素，并探索减少诊断错误的策略。病例介绍 研究期间为 2001 年 1 月至 2017 年 8 月。收集了曾就诊于近台大学医院及其分院、堺医院和日本桥诊所的心身医学科的患者资料。所有患者的年龄均在 16 岁或以上。多种因素，如年龄、性别、出现症状、初步诊断、最终诊断、从20例患者的病历中回顾性分析重诊来源及误诊类型。其中，四个典型案例可描述如下。情况1; 一名79岁的女性，最初诊断为抑郁症导致的心因性呕吐，最终诊断为胃扭转。案例2；一名 24 岁的男子，被诊断患有饮食失调症，后来改为食管贲门失弛缓症。案例10；一名 60 岁女性的诊断从转换障碍变为局部肌肉萎缩。案例 19；一名 68 岁的男性，因癌症导致的抑郁症导致食欲不振，转为继发性肾上腺皮质功能不全，孤立性促肾上腺皮质激素缺乏症 (IAD)。结论本研究表明，与误诊相关的多种因素综合作用，相互影响。然而，它们可以概括为两个重要的临床观察，诊断系统相关问题和提供者问题。提供者问题主要包含认知偏差，例如锚定、可用性、确认偏差、延迟诊断和代表性。为了避免诊断错误，既需要诊断系统方法，又需要减少认知偏差。心身医学医生应该更多地关注身体症状和全身检查，并且可以在基于良好、不带偏见的医患关系接受患者感知方面发挥重要作用。为了避免诊断错误，既需要诊断系统方法，又需要减少认知偏差。心身医学医生应该更多地关注身体症状和全身检查，并且可以在基于良好、不带偏见的医患关系接受患者感知方面发挥重要作用。为了避免诊断错误，既需要诊断系统方法，又需要减少认知偏差。心身医学医生应该更多地关注身体症状和全身检查，并且可以在基于良好、不带偏见的医患关系接受患者感知方面发挥重要作用。