When Doctors Get It Wrong: The impact of Misdiagnosis on Career Trajectory

Careers rarely follow a straight path. For some people, misdiagnosis can impact health, treatment, recovery, and professional life. Conditions with variable or intermittent symptoms, such as ADHD, autoimmune disorders, or mental health conditions, are particularly at risk of misdiagnosis. Fluctuating or atypical symptoms complicate treatment, prolong recovery, and influence career trajectories. Information received from medical professionals is often considered accurate and can significantly influence decisions made about long term life goals. When a patient a receives a diagnosis, they are often balancing responsibilities across multiple life domains, making the impact of such diagnoses quite significant and in some instances, life altering.

What is Misdiagnosis and Why Variability Matters

Misdiagnosis occurs when a medical or psychological condition is incorrectly identified or overlooked. Symptom variability increases the likelihood of misdiagnosis because:

• Symptoms can be intermittent or mild at times, making the condition less obvious during clinical assessment.

• Presentation may not match typical diagnostic patterns, particularly for neurodivergence or chronic illnesses.

• Overlap with other conditions can lead to confusion and inappropriate treatment.

• Individual differences (age, gender, lifestyle, and context) can change symptom expression, leading to inconsistent clinical impressions. (Silverman et al., 2015; Hiller et al., 2014).

Variable symptoms can delay diagnosis, complicate treatment, and make workplace performance less predictable, affecting both short and long term career outcomes. For mental health conditions, neurodivergence, and chronic illnesses, diagnosis is often more accurate when assessed over time, which contrasts with common clinical practice. The diagnostic process can be influenced by reliance on a limited number of interviews, self-report questionnaires, parent or teacher feedback that may reflect subjective bias, and brief inferences from other practitioners. Collectively, these factors increase the likelihood of diagnostic error.

Impact on Treatment and Recovery

Fluctuating symptoms make treatment and recovery more difficult when a short term approach to diagnosis is undertaken. This often results in:

Delayed or inappropriate treatment

Clinicians may misattribute inconsistent symptoms to stress, mood, or lifestyle rather than an underlying condition.

Trial-and-error interventions

Treatments may require frequent adjustment as symptoms vary, prolonging recovery and reducing effectiveness.

Psychological stress

Variable symptoms and misdiagnosis can cause frustration, anxiety, and decreased confidence in health management (Kessler et al., 2010).

For example, adults with ADHD who experience intermittent focus and productivity may be misdiagnosed with anxiety or depression, resulting in treatments that do not address executive functioning challenges. Similarly, autoimmune or inflammatory conditions such as endometriosis, may present with fluctuating fatigue and pain, which, if misdiagnosed, can delay interventions and affect day-to-day functioning.

Career Implications of Symptom Variability and Misdiagnosis

Misdiagnosis combined with variable symptoms can affect careers in several ways:

Unpredictable Work Capacity

Fluctuating symptoms may impact attendance, deadlines, or consistent performance, creating barriers to promotion or advancement.

Delayed Career Progression

Persistent but misunderstood difficulties can slow professional development, limit opportunities, or necessitate role changes.

Role Misalignment

Without accurate diagnosis, individuals may select roles incompatible with their abilities, leading to dissatisfaction and disengagement.

Psychological Impact

Variable symptoms and misdiagnosis can erode confidence, reduce motivation, and increase stress, indirectly affecting career decisions.

Disclosure and Accommodation Challenges

Employees may hesitate to request support for fluctuating symptoms if previous experiences of misdiagnosis were invalidating, reducing access to workplace accommodations (Santuzzi et al., 2014).

Who is Most Affected?

Symptom variability disproportionately affects certain populations:

• Women and minority groups, who may experience minimised or misattributed symptoms, particularly for neurodivergence or mental health conditions (Bejerot et al., 2020).

• Adults with late-diagnosed neurodivergence, who may have spent years working without understanding fluctuating cognitive or executive challenges (Hiller et al., 2014).

• Individuals with chronic or fluctuating illnesses, where day-to-day function varies widely, complicating career management (Burton et al., 2004).
  

Strategies to Manage Variable Symptoms at Work

While misdiagnosis and symptom variability can disrupt careers, individuals can take steps to mitigate their impact:

Seek Reassessment and Specialist Input

Second opinions or specialist evaluations can clarify the diagnosis and guide effective treatment (Silverman et al., 2015).

Document Symptom Patterns

Tracking fluctuations and triggers provides valuable information for clinicians and helps employees communicate their needs to employers.

Utilise Workplace Supports

Flexible hours, task adjustments, remote work, and assistive technologies can help employees manage days of high or low capacity (Schur et al., 2014).

Professional Guidance

Occupational psychologists, guidance counsellors, and mentors can advise on navigating career paths that accommodate variable performance (Burke et al., 2020).

Peer and Support Networks

Connecting with others facing similar challenges provides practical guidance and emotional support.

Employer Considerations

Employers can help reduce the career impact of misdiagnosis and variable symptoms by:

Raising Awareness

Managers trained to recognise that fluctuating performance may reflect untreated or misunderstood conditions can avoid misjudging employees.

Flexible Policies and Accommodations

Modified workloads, flexible leave, and role adjustments support employees in maintaining professional continuity despite variability.

Psychologically Safe Environments

A workplace culture that encourages open discussion of health challenges supports sustained career engagement and professional growth (Edmondson, 2018).

Final Thoughts

Misdiagnosis, particularly when symptoms are variable, can disrupt treatment, recovery, and careers. Fluctuating or atypical symptoms make diagnosis more difficult, which can delay effective treatment and complicating workplace functioning.

Awareness, reassessment, workplace accommodations, and personal advocacy are key strategies for mitigating these impacts.

Supporting employees navigating misdiagnosis and variable symptoms helps maintain professional growth, confidence, and long-term career potential.

If you're experiencing unexplained symptoms or struggling at work due to health challenges, speak with one of our psychologists to get clarity, support and a tailored plan for recovery and management.

References

Silverman, J., et al. (2015). Misdiagnosis in adult ADHD: Consequences and guidance. Journal of Attention Disorders, 19(3), 180–191.

Hiller, R. M., et al. (2014). Late-diagnosed adults with autism: Misdiagnosis and occupational outcomes. Autism Research, 7(5), 536–543.

Kessler, R. C., et al. (2010). The global burden of mental disorders. Psychological Medicine, 40(1), 1–15.

Santuzzi, A. M., et al. (2014). The disclosure dilemma for employees with invisible disabilities. Journal of Occupational Health Psychology, 19(2), 123–134.

Bejerot, S., et al. (2020). Gender and ethnicity differences in misdiagnosis of neurodevelopmental conditions. Research in Autism Spectrum Disorders, 75.

Burton, W. N., et al. (2004). The impact of chronic health conditions on work performance. Journal of Occupational and Environmental Medicine, 46(6), S38–S45.

Schur, L., et al. (2014). Accommodations and employment outcomes for workers with disabilities. Industrial Relations, 53(3), 545–568.

Burke, R., et al. (2020). Peer networks and employee support for chronic illness. Journal of Workplace Behavioral Health, 35(4), 271–289.

Edmondson, A. (2018). The Fearless Organization: Creating Psychological Safety in the Workplace. Wiley.