Can "misdiagnosis" also harm your health? The "disease perception" in "Zhou Chu Eliminates Three Evils" really exists!

"Zhou Chu Eliminates Three Evils" is a story in Shiyu Xinshuo. Zhou Chu was a descendant of a general in the Western Jin Dynasty. However, because his father died early and his mother doted on him too much, he became rampant in the village and was called "three evils" by the villagers, along with the fierce tiger in the South Mountain and the dragon in the West Lake. Zhou Chu repented after learning about this, killed the fierce tiger and the evil dragon, and turned over a new leaf, eliminating the "three evils" in the city.

The movie "Zhou Chu Eliminates Three Evils" borrowed this allusion. The "three evils" are three wanted criminals who committed heinous crimes but are still at large. Chen Guilin, ranked third, has been on the run for four years. After his grandmother passed away, the pharmacist who had been helping the underworld told Chen Guilin that he had lung cancer and it was in the terminal stage. He could only live for half a year at most. So Chen Guilin decided to follow Zhou Chu's example and eliminate the other two evils to make himself "famous".

After getting rid of the first two evils, Chen Guilin surrendered to the police, but after being imprisoned, he learned that he did not have cancer. The pharmacist herself was the one who had cancer. She told Chen Guilin that she had cancer just to persuade Chen Guilin to surrender so that she could "go on the road with peace of mind."

A key factor in driving the entire plot is that Chen Guilin learned that he was in the "terminal stage of cancer", which not only became the protagonist's motivation for behavior, but also affected his physical condition. After knowing his "cancer diagnosis", Chen Guilin decided to "do something big". As he acted, more and more "cancer" symptoms appeared on him: constant coughing, taking medicine more and more frequently, withered and black face, increasingly thin body, and even "spitting black water" later, all reminded Chen Guilin and the audience that he was really terminally ill and was about to die. But after being imprisoned, Chen Guilin knew that he did not have cancer. Although he was still very thin at this time, his complexion was significantly better than before, and even a little rounder.

Although it is portrayed in the movie, people's perception of the disease does affect physical health and symptom manifestations. Disease perception is a cognitive representation of disease and treatment, which refers to the patient's subjective cognition of using previous disease information and experience to explain current symptoms. People's perception of disease is closely related to health outcomes and treatment effects. Even if the symptoms are the same, there will be different results due to different disease perceptions. Positive disease perception is associated with better health outcomes, while negative disease perception is associated with worse outcomes. For example, if you think that the disease is related to bad living habits, you may take action to change bad habits. If a certain method is effective in relieving symptoms, it will also increase confidence and have a positive impact on the treatment effect. On the other hand, if you hold a negative attitude of "I'm going to die soon" and "It can't be cured", you may be like Chen Guilin, breaking the jar and breaking it.

There are five main aspects of disease perception: qualitative, timeline, results, causes, and whether it is curable/controllable. People will form a qualitative description of existing symptoms based on symptoms and knowledge of the disease: What disease do I have? With clear labels, people can better understand their symptoms and thus have more confidence in controlling the disease. For example, compared with patients who are told that heart disease causes chest pain, unexplained chest pain will make patients feel more difficult to control. People will also conduct self-examinations based on existing knowledge to detect health risks early. For example, breast examinations can help women detect breast cancer as early as possible, but not all breast cancer patients have lumps. Because there are no symptoms that match the disease, those who do not have lumps often seek treatment later. The "labels" attached to oneself will also affect physical feelings in turn: I have this disease, so I "should" have symptoms. For example, people believe that high blood pressure should have certain symptoms. In experiments, those who received high blood pressure readings also reported more symptoms related to high blood pressure, and those who felt they had high blood pressure also had more absences.

In the movie, Chen Guilin almost immediately accepted his diagnosis of "advanced cancer". He trusted the doctor and had no other way to see a doctor. However, after receiving a terminal illness diagnosis, ordinary patients often go through five stages: "denial-anger-bargaining-depression-acceptance", which is also closely related to the patient's disease perception. For example, in the denial stage, patients and their families do not believe in the terminal illness diagnosis, let alone the imminent death. They often think that the diagnosis is wrong. In the bargaining stage, they believe that they can "make a deal with the god of death" and can intervene in the development of the disease and the treatment effect by changing their behavior. Dr. Chen Guilin's "disease perception" is related to her understanding of the cause and result of the disease: she believes that her terminal illness is related to her continuous assistance to the gangs and "too many sins", and by persuading Chen Guilin to surrender, she can "go on the road with peace of mind".

There is another plot in the movie where Chen Guilin enters the "spiritual center" and is misled by the "venerable" into thinking that his illness has improved, and his disease perception has also changed significantly. When facing health threats, the perception and cognition of symptoms, as well as existing knowledge, will form an assessment and judgment of the disease, thereby formulating a response strategy for the disease threat. In the future, according to the feedback from the development of the disease, the effect of treatment, etc., new information and available resources will be integrated, and the response strategy will be continuously adjusted to improve healthy (or unhealthy) behaviors. In the movie, the "venerable" uses deceptive means to create or aggravate the disease, and creates the illusion of "recovering health", making people believe that he "cured" the disease, and through manipulation to change people's disease perception about treatment, ultimately achieving the purpose of brainwashing believers.

At the end of the article, we have to talk about the "misdiagnosis" in the movie. Although Chen Guilin's "misdiagnosis" in the movie was a pharmacist's self-interest in deceiving the "patient", misdiagnosis in reality is not an isolated incident. Misdiagnosis means "a diagnosis is unintentionally delayed, misdiagnosed (another diagnosis is made before the correct diagnosis) or omitted (no diagnosis is ever made) based on the final judgment of more clear information."

The causes of misdiagnosis can be divided into three categories. The first category is non-negligence, such as inaccurate information provided by the patient himself, or atypical symptoms; the second category is systematic errors, such as technical obstacles, equipment failures, etc.; the third category is cognitive errors caused by doctors, such as lack of medical knowledge, lack of dialectical thinking (for example, more common or familiar diagnoses are preferred), and premature diagnosis (once a possible diagnosis is determined, other options are no longer considered). According to research results published in 2024, the average misdiagnosis rate for 15 diseases in the three major categories of cardiovascular, infection and cancer in the United States from 2012 to 2014 was 11.1%. Serious injuries caused by misdiagnosis accounted for 4.4% of all diagnoses, that is, there were nearly 800,000 deaths (about 371,000) or permanent disabilities (424,000) in three years. Compared with common diseases, the misdiagnosis rate of rare diseases is higher. Studies have shown that patients with rare diseases have to see an average of 7.3 doctors and experience 4.8 years before they get a correct diagnosis.

Misdiagnosis can seriously affect the timing of patients receiving correct treatment. Patients and their families may experience more physical and mental pain, increase the burden of treatment, and cause patients to have a wrong perception of the disease. On the basis of accurate diagnosis, establishing a correct and positive disease perception can improve the patient's treatment effect and quality of life, and can also help healthy people live healthier lives.