Avoiding diagnostic overshadowing

Diagnostic overshadowing is when a new health problem is wrongly attributed to a person's disability. Reception staff do not diagnose, but they can ensure new concerns are passed on and not dismissed.

Take new concerns seriously

A person with a learning disability may show illness differently. Pain, infection, medication side effects, distress, constipation or dehydration can appear as changes in behaviour, withdrawal, agitation or repeated contact.

Reception staff should record the exact words used and the specific changes observed, rather than labelling them simply as "behavioural". If a carer reports the patient is "not themselves", record that detail.

Listen for change

• New confusion, drowsiness, pain or distress.
• Sudden change in eating, drinking, toileting or mobility.
• Repeated contact where the plan is not working.
• Carer concern that this is not normal for the patient.

Do not let a known learning disability hide a new health or safety concern.

When the concern is new or different from usual, keep the details and pass them to the appropriate clinical route instead of explaining it away at reception.

Illness can present as behaviour change, reduced communication or withdrawal. Recording what is different from the person's usual presentation gives clinicians more useful information than labels such as "agitated" or "difficult".

Diagnostic overshadowing can start with language. Recording a new symptom merely as "behaviour" risks missing clinical significance. Factual descriptions protect the patient.

Clinical background