Does diagnosing a patient with borderline personality disorder negatively impact patient satisfaction with the initial diagnostic evaluation?

BACKGROUND: Research has found that clinicians have less sympathetic attitudes and behave less empathically toward patients with borderline personality disorder (BPD). Anecdotal conversations with clinicians and trainees reveal that some have a reluctance to tell their patients that they have BPD due to a concern that these patients will react badly. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined whether diagnosing BPD resulted in lower satisfaction with the initial evaluation. METHODS: One thousand ninety-three patients presenting to the Rhode Island Hospital partial hospital program completed the Clinically Useful Patient Satisfaction Scale (CUPSS), a reliable and valid measure of satisfaction with the initial evaluation. The usual clinical practice in our program is to discuss with the patients their diagnoses. RESULTS: Approximately one-sixth of the patients were diagnosed with BPD (15.6%, n = 171). There were no significant differences in satisfaction ratings on the 16 items of the CUPSS between patients with and without BPD. CONCLUSIONS: There was no evidence that diagnosing BPD was associated with reduced satisfaction with the initial diagnostic evaluation. Approaches toward making the diagnosis of BPD also are discussed.

Psoas abscess in an immunocompetent host.

We present a case of iliopsoas abscess in an immunocompetent patient. She experienced three weeks of worsening right hip pain, which was initially misdiagnosed as degenerative joint disease. This led to admission to the Intensive Care Unit for severe sepsis. The patient improved with intravenous antibiotics and percutaneous abscess drainage.