Ulysses syndrome (redirected from Mischievous/unnecessary investigation)

Ulysses syndrome

Ulysses sequence Decision-making A complication of false-positive diagnostic tests or clinical observations that trigger a complete and aggressive diagnostic work-up to elucidate the nature of what is, in fact, a non-disease, before the Pt can return to an original state of health

Ulysses syndrome–triggering events

Mischievous/unnecessary investigation That which is motivated by mass screening, eg 'blanket coverage' to pay for testing by an insurance company, house-staff 'overkill' to avoid criticism, requisition forms which have the laboratory's entire menu

Uncritical examination Lack of familiarity with a body region may mislead the examiner, especially if he encounters trivial anatomic variations of normal structures

Serpentino 'complex' Two snakes consuming each other tail first. A neurotic Pt may succeed in making himself ill when there is unexpected interest in an otherwise trivial complaint

Inverted serendipity While Marie Curie's serendipitous dropping of a key on a pile of photographic film near radium was the founding event of radiology, 'discoveries' made while using an unfamiliar technique are usually 'red herrings'

Non-investigational investigation When a laboratory request form has a new test on it, the new box is checked off with disproportionate frequency

A review of statistical principles in lab medicine makes it surprising that the Ulysses syndrome doesn't occur more often, since results of certain lab tests are placed on a standard Gaussian curve of distribution and any value > 2 standard deviations–SD above or below a mean is considered statistically abnormal (not biologically abnormal); this verification process is a function of daily fluctuations of machinery and other non-disease factors; thus 5%, ie, 1 in 20 of any normal population will be > 2 SD from the mean of a value, and therefore, abnormal; 1 in 400 normal subjects will be statistically abnormal in 2 tests and so on

Ulysses, who fought in the Trojan war, required 20 years for the return leg of the journey; all of the harrowing detours were unnecessary