In healthcare, the term “Rashomon effect” captures the unsettling reality of multiple, often conflicting, diagnoses. This term, taken from Akira Kurosawa’s classic film Rashomon, describes situations where different perspectives lead to different interpretations of the same event. In the medical field, this effect can leave patients uncertain, vulnerable, and searching for a diagnosis they can trust.
Rachna Bhutoria, a 28-year-old public relations professional in Bengaluru, faced this exact challenge. Persistent joint pain led her to seek help from highly qualified specialists across cities, each offering a different diagnosis. “Each doctor gave conflicting diagnoses — from rheumatoid arthritis to hypermobility syndrome to ankylosing spondylitis, and finally mechanical back pain,” she recalls. For her, what began as a search for relief spiraled into confusion as she grappled with a cascade of professional opinions, all rooted in evidence but divergent in conclusion.
Doctors and healthcare professionals acknowledge that the Rashomon effect is a common phenomenon, particularly in cases where symptoms are ambiguous or overlap with multiple potential conditions. According to Dr. Sameer Kulkarni, a rheumatologist based in Mumbai, complex conditions often present diagnostic challenges that lead to varied interpretations. “Medicine is a science, but it’s also an art that requires experience and interpretation,” he explains. “Different doctors bring their own backgrounds, biases, and specializations to the table, so naturally, their approaches to the same symptoms can differ.” This diversity of perspectives, while beneficial in many ways, often places patients in a position where they must decide which path to follow without a clear sense of what’s best.
Another factor contributing to this effect is the speed and volume of technological advancements in healthcare. Dr. Nidhi Shah, an internist from Pune, points out that while advanced diagnostic tools can capture detailed images and metrics, interpreting these findings accurately still depends heavily on human analysis. “We rely on advanced tests and screenings, but the data can be complex. Radiologists, pathologists, and specialists might each see the same scan differently. It’s all in the training and focus of the individual doctor.”
Patients, in their search for certainty, may turn to multiple specialists, hoping that additional consultations will lead to a consensus. However, consulting more doctors does not always clarify the issue; rather, it often introduces more opinions. Each specialist may focus on a specific field or concern, leading to diagnoses that don’t always align. Dr. Kulkarni observes that patients who have undergone several tests with differing results may feel even more trapped in a maze of contradictions. “In many cases, patients end up with more questions than answers, and that frustration can be very disheartening.”
For patients, navigating these differing medical opinions requires careful, proactive decision-making. Some patients seek a primary care physician who can act as a central figure, someone who understands their history, synthesizes various opinions, and helps them weigh the merits of each diagnosis. According to Dr. Shah, continuity of care can sometimes cut through the confusion by building a baseline understanding of the patient’s health history. “When a single physician oversees a patient’s healthcare journey, they’re better positioned to weigh the relevance of different diagnoses over time, instead of treating each new opinion as equally likely.”
The emotional toll of this uncertainty is another significant concern. Constantly shifting diagnoses can lead patients to doubt the reliability of the medical profession and even their own perceptions of their health. Bhutoria, for instance, mentions feeling as if she were “on a diagnostic rollercoaster.” Patients in similar situations often struggle with anxiety and stress, caught between wanting to trust medical experts and feeling as though they must advocate for themselves to find a solution.
The Rashomon effect in healthcare underscores the need for open, empathetic communication between patients and their providers. According to Dr. Shah, “When doctors take the time to explain the reasons behind each diagnosis, including its limitations, patients feel more involved in their care process.” By acknowledging that medicine isn’t always an exact science, providers can help patients understand why varying opinions may arise.
In response to these challenges, some hospitals have introduced multidisciplinary teams for complex cases, where specialists across fields collaborate to provide a more unified diagnosis. This approach leverages diverse expertise, reducing the likelihood of contradictory opinions and offering patients a sense of resolution. While it’s not a perfect solution, the collaborative approach can offer a degree of clarity that a series of isolated consultations may lack.
The uncertainty brought on by conflicting medical opinions can also highlight the growing importance of a patient-centered approach in healthcare. Patients, after all, are more than their symptoms—they are individuals with unique health histories, emotional needs, and concerns. This approach emphasizes the value of listening to patients’ stories, understanding their fears, and guiding them compassionately through their options. Dr. Kulkarni notes that when doctors involve patients in the diagnostic process and give them a voice in decision-making, it fosters a partnership rather than a hierarchy. “Patients who feel heard and informed are more empowered, which can actually lead to better outcomes.”
Another emerging trend to help mitigate the Rashomon effect is the rise of telemedicine and digital health records. With these tools, patients can access second opinions from specialists around the world, bridging gaps in expertise and allowing patients to consult a broader range of professionals. Digital records can also streamline the sharing of previous test results, reducing redundant testing and helping different doctors see the same comprehensive medical history. This continuity can sometimes lessen the discrepancy between diagnoses, as all specialists are working from the same, updated information.
For patients experiencing the Rashomon effect firsthand, it’s important to practice self-advocacy. Seeking clarification, asking questions, and even challenging certain aspects of a diagnosis can help in understanding the logic behind each doctor’s opinion. Dr. Shah encourages patients to openly discuss their doubts and concerns with their healthcare providers. “Medicine can be complex, but patients should never feel intimidated to ask for explanations. A good doctor will respect the need for clarity and take the time to provide it.”
In some cases, patients may find it beneficial to seek out healthcare providers who specialize in holistic or integrative medicine. These practitioners often prioritize the whole-body perspective, aiming to understand the interplay of various factors that could contribute to confusing symptoms. Holistic approaches often focus on preventive care and lifestyle adjustments, adding another layer to traditional treatment approaches and sometimes bringing clarity where conventional methods have left questions unanswered.