Ulysses syndrome

Ulysses syndrome2016-12-10T20:25:10+00:00

Ulysses syndrome

Ulysses syndrome image from New Medical Terms

Ulysses tied to his ship’s mast

EVIDENCE-BASED MEDICINE

A popular term for a complication of false-positive diagnostic tests1 or clinical observations which trigger a complete and aggressive diagnostic work-up to elucidate the nature of what is, in fact, a non-disease, before the patient can return to an original state of health2

1A review of statistical principles in lab medicine makes it surprising that the Ulysses syndrome doesn’t occur more often, as results of many 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%, i.e., 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 2Ulysses, who fought in the Trojan war, took 20 years for the return leg of the journey; all of the harrowing detours were unnecessary

Ulysses syndrome–triggering events

Mischievous/unnecessary investigation That which is motivated by mass screening, e.g., ‘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’ Serpentino = two snakes consuming each other tail first A neurotic patient may succeed in making himself ill when there is unexpected interest by a doctor or other health professional 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

Synonym Ulysses sequence 

Reference Canadian Medical Association Journal 1972; 106:122-1231

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