Imagine you are seeking a diagnosis, expecting clear answers — yet each healthcare provider you consult offers a different interpretation of your symptoms. This puzzling phenomenon is known as the Rashomon effect, a term inspired by Akira Kurosawa’s film Rashomon, where multiple characters recall the same event in wildly different ways. In healthcare, where clarity and trust are essential, the Rashomon effect captures the challenge of navigating differing expert opinions. It arises when doctors, shaped by their unique perspectives and expertise, interpret the same symptoms in distinct ways, leaving patients feeling confused, uncertain about whom to trust, and overwhelmed by the varying paths to treatment.

Himanshi Parihar, a marketing manager from Hyderabad, describes a similar experience. “I began experiencing persistent stomach issues and was advised to avoid eating outside or oily food. Around the same time, I was diagnosed with anxiety, and my stomach problems were attributed to that,” she mentions.

When anxiety medication made her feel lethargic, she sought a second opinion and was diagnosed with bipolar disorder. However, the stomach issues persisted and worsened, affecting her daily life with ongoing symptoms of diarrhoea and gastroesophageal reflux disease (GERD), which doctors continued to attribute to lifestyle factors. “Finally, 6-8 months later, someone suggested a food intolerance test, which clarified everything. It turned out I had high intolerance to many staples of the Indian diet, such as gluten and lentils.”

Sneha Gupta, a holistic life coach from Mumbai, experienced rashes on her scalp, face, and legs, which she thought were seasonal. She was prescribed medication for what was assumed to be psoriasis, which cleared her symptoms temporarily. However, the rashes reappeared once she stopped the medication, prompting her to consult a second doctor, who provided a different diagnosis and lighter medication.

Despite this, the problem persisted, leaving the 35-year-old frustrated and unsure about the accuracy of either diagnosis. “It was unsettling when they told me they weren’t sure what was causing my symptoms. It was frustrating to feel that even the experts didn’t know.” The repeated flare-ups and lack of a definitive diagnosis led her to take control of her health by focusing on lifestyle changes rather than solely relying on medications, but the issue persists.

On patients receiving conflicting diagnoses

“Yes, conflicting diagnoses are not uncommon in clinical practice,” says Dr C M Nagesh, senior consultant cardiologist and general secretary at Indian College of Cardiology. “ Often, I encounter patients who come with several opinions, each suggesting a different diagnosis. This can be quite overwhelming for patients.”

Dr Suri Raju V, senior consultant urologist and general secretary, IMA Karnataka, says, “I have encountered countless cases where patients have been bounced between specialists, each offering a different diagnosis for the same set of symptoms.”

Dr Nivedita Pandey, senior gastroenterologist & hepatologist and director of Dr Good Deed Clinic, explains that this typically occurs with patients presenting non-specific symptoms – like pain, headache, or nausea – that don’t suggest life-threatening conditions. “When symptoms are vague or less severe, they often allow for multiple possible diagnoses, leading to varied assessments.”

Dr Mayanka Lodha Seth, chief pathologist at Redcliffe Labs, clarifies this with an example. “One well-known example of the Rashomon Effect in medical diagnostics is the case of multiple sclerosis (MS), a complex and unpredictable neurological disorder,” she states, adding that patients with multiple sclerosis often experience symptoms like fatigue, muscle weakness, and vision issues, which are common to a variety of other medical conditions.

“A general physician might interpret persistent fatigue as a sign of chronic fatigue syndrome, especially if other symptoms seem mild or intermittent. Meanwhile, a psychologist or psychiatrist may consider a diagnosis of depression, interpreting fatigue and weakness as potentially linked to mental health. Finally, a neurologist trained to recognise complex patterns of neurological disruption may suspect multiple sclerosis as they consider the broader range of subtle neurological signs that often accompany MS,” she says.

Can starting with a primary care physician or GP could reduce the risk of conflicting diagnoses?

“Starting with a primary care physician or GP can significantly reduce the risk of conflicting diagnoses,” Dr Suri Raju acknowledges. “Primary care physicians have a broader understanding of overall health and can consider various potential causes for a patient’s symptoms.”

Primary care physicians (PCPs) often have a long-standing relationship with their patients, providing them with a deeper understanding of the patient’s medical history, lifestyle, and overall health trajectory. This continuity of care can be invaluable in guiding diagnostic decisions, Dr Suri Raju adds.

That said, Dr Nagesh highlights that while primary care physicians are generalists who are well-equipped to take a holistic view of the patient’s symptoms, they “may not have the same level of expertise as specialists in complex or rare conditions, so their role is best seen as an initial guide.”

Dr Chandril Chugh, senior neurologist and director of Dr Good Deed Clinic, concurs, “For complex cases, a PCP might still refer patients to multiple specialists, which can result in differing opinions.”

Handling situations involving conflicting medical opinions

“I encourage patients to openly discuss the differences and seek a second opinion if necessary. I focus on helping them understand the rationale behind each diagnosis rather than the discomfort of contradiction,” notes Dr Vikas Mittal, pulmonologist, director, Wellness Home Clinic and Sleep Centre, Delhi. 

This process empowers patients, he explains, allowing them to make “informed decisions” by understanding the “underlying reasons for each perspective.” Dr Chugh adds that reviewing previous records and seeking additional opinions are often helpful. “Educating patients on the possibility of evolving or multifaceted diagnoses helps manage their expectations.”

“I approach the situation with the understanding that each diagnosis reflects the point at which a doctor saw the patient,” says Dr Pandey. 

A key approach is to involve the patient in shared decision-making, says Dr Nagesh. “I outline the possible reasons behind each diagnosis and discuss the potential benefits and risks of pursuing each avenue of care. If needed, I may suggest additional tests to address any grey areas or refer the patient to another specialist for a second opinion.” 

What healthcare providers can do

According to Dr Seth, the first step is to “ensure clear communication.” She believes that explaining the diagnoses and reasoning in simple terms to the patient, noting any uncertainties or alternative possibilities, can remove any confusion for the patient. Additionally, she says that sharing records and consulting with other healthcare providers can create a unified understanding.

Dr Pandey agrees, “While longer consultations may not always be feasible due to the high demand for healthcare services, even an 8-10 minute focused discussion can make a significant difference.”

Appointing a primary provider to oversee and synthesise differing inputs can also help, highlights Dr Chugh.