Avoiding “scapegoat diagnoses”  

By Christina D’Agostino, MD, Johns Hopkins Medicine  

Women with serious medical conditions are often misdiagnosed with anxiety, depression, or other mental health disorders1. For example, over one-third of endometriosis patients are initially given a psychological diagnosis, resulting in delays of more than four years and consultations with an average of seven different physicians before receiving the correct diagnosis. This pattern isn’t exclusive to endometriosis. Many women who eventually received diagnoses of systemic lupus erythematosus and other autoimmune conditions report similar experiences.

This phenomenon—where psychological explanations are prematurely applied to women’s physical symptoms—is increasingly recognized as the “scapegoat diagnosis.” It not only delays appropriate treatment but also reflects deeper gender biases in the medical system. 

Take endometriosis as a case in point. The condition presents diagnostic challenges: symptoms are often nonspecific, there are no definitive biomarkers, and public and professional awareness remains low. Contributing factors include time constraints during appointments, a reluctance to express diagnostic uncertainty, cognitive biases like anchoring on prior diagnoses, and a possible over-reliance on “illness scripts” ingrained during medical training. Together, these factors create a perfect storm for misdiagnosis. 

This misattribution is not simply a diagnostic oversight—it underscores a broader systemic issue. Medical research and education have historically marginalized women’s health concerns, leading to the minimization of their pain and the perception that they are exaggerating or imagining symptoms. Consequently, women often receive less aggressive diagnostic workups and treatment compared to men. A 2019 study found that general practitioners were more likely to diagnose a female patient with back pain as having “medically unexplained symptoms” (MUS), compared to an otherwise identical male patient. This bias persisted even after accounting for the physician’s experience, age, and gender.

Strategies for clinicians  

To provide equitable and effective care for women that circumvents the “scapegoat diagnosis,” clinicians must take proactive steps: 

1. Comprehensive assessment

Consider both physical and psychological causes without defaulting to one based on gendered assumptions. Let symptoms guide the investigation, not stereotypes. 

2. Active listening

Validate the patient’s experiences and concerns. A woman’s report of her symptoms isn’t anecdotal—it’s clinical data.

3. Normalize diagnostic uncertainty

Acknowledge uncertainty as part of medical practice. When answers are unclear, communicate transparently with patients—statements like “We don’t have all the answers yet, but I believe you and we’ll keep working on this together” can reduce anxiety and build trust.

4. Ongoing education

Stay current on sex- and gender-specific health issues and reinforce accurate use of psychiatric diagnoses. 

5. Team-based care

Collaborate with specialists across disciplines, including mental health professionals, to ensure a well-rounded diagnostic approach.

6. Cultural competence

Be sensitive to how cultural, racial, and social factors shape how women express and experience illness. 

7. Advocate for women’s health research

Support and engage in efforts to expand research focused on women’s health conditions, which remain underfunded and understudied compared to conditions that primarily affect men8.

Delivering high-quality healthcare to women means going beyond symptom management—it means questioning assumptions, closing diagnostic gaps, and honoring the complexity of each patient’s story. By addressing systemic biases and embracing a patient-centered approach, clinicians can foster a more inclusive, accurate, and compassionate medical practice. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.