During lunch the other day in my hospital’s cafeteria, I mentioned to my colleagues that in my recent poll of multiple sclerosis (MS) patients, the vast majority seemed to have symptoms of obstructive sleep apnea or upper airway resistance syndrome: Severe parental snoring, cold hands or feet, never being able to sleep on their backs, and frequent trips to the bathroom at night. Immediately they reflexively dismissed a possible association and attributed the symptoms to neurologic reasons.
The same situation occurs with patients as well, especially if they already have one (test) confirmed diagnosis. Any other or unusual signs or symptoms are attributed to their original medical diagnosis and a search for other possible causes is never perused.
Many people will develop obstructive sleep apnea as they age. It’s estimated that about 1/4 of all men and 1/10th of all women have obstructive sleep apnea in this country. Eighty to ninety percent are thought not to be diagnosed. After age 60, a majority of people probably have some degree of sleep apnea. If that person already has another diagnosis (such as MS), then symptoms such as fatigue, insomnia, and headaches will automatically be blamed on MS, no matter how unusual.
In the classic book, Influence: The Science of Persuasion, by Dr. Robert Cialdini, he brings up the concept of commitment and consistency. Once you’re committed to something, how you behave and think has to be consistent with your original commitment. The same process applies with medical diagnoses, to a certain degree.
In this era of information overload for both patients and physicians, it’s no wonder that alternative or additional possible explanations are not looked into once you already have another diagnosis. Not only are you bringing into doubt the original diagnosis, but it also just takes too much time and energy.