In the majority of cases, late diagnosis is usually a consequence of inadequate knowledge and poor diagnostic skills on the part of doctors. TS is not a rare condition and has a complex but comparatively unambiguous clinical presentation. Doctors like to cite an assumed rarity as a reason for not having sufficient knowledge. The reason they have not supposedly encountered it (it's the same with teachers who say they have never seen a child with it) is because they are often unable to recognise it and often have an erroneous perception of the symptomatology.
Misdiagnoses abound and include depression (most common), psychosis (schizophrenia), bipolar affective disorder, ADHD, autism and personality disorders. TS is actually a relatively easy disorder to diagnose and few other conditions are closely similar in terms of the combination and expression of symptoms. Compare for instance with Asperger's or high-functioning autism which has a broadly similar incidence but is extremely hard to determine in some individuals.
There are few excuses for a lack of knowledge in medicine. Doctors are professionally bound to be competent and to ensure their knowledge and ability to manage the conditions they encounter is not wanting. They should be honest if they do not understand something outside their competencies. In that circumstance they must refer to an appropriate specialist. It is unprofessional to falsely claim an ability to diagnose or treat a condition. There have been a number of court cases resulting from missed or misdiagnosis of TS where negligence or incompetence has been claimed. The defence is usually that it is a consequence of 'ignorance' rather than 'negligence' and that TS is a 'rare' condition.
Why are so many doctors unable to correctly recognise disorders such as TS that have very overt symptom patterns and are in hindsight unmistakable? I personally know of doctors who have failed to detect serious life-threatening conditions that had very clear presentation (symptoms and signs) that would not be missed by any medical student, who would have been 'failed' had they done so. As patients we must demand higher standards and ensure we are better educated ourselves about TS and it's pharmacology than many of the physicians who claim expertise. In many cases this is not too difficult! There are many good doctors but still too many who get things wrong without reason. Although with some the reason is one of personal opinions and stereotypical thinking and not based on evidence or good awareness of the medical literature.
I feel a need to rant a little on this issue. My own parents were told by doctors 'it is just a habit he will grow out of' and that it was nothing to worry about and then later, when TS was eventually established as the diagnosis, I was informed 'it will get better as you get older and disappear' well I didn't and it hasn't. I now know many children and adults with TS and they offer collectively a very different perspective of the disorder, one brought about by first-hand experience and knowing existentially what it is like. It is not just about what others see (including physicians) e.g. some of the more noticeable 'tics' - there is so much more and that is the part that is usually 'for life' and that gives the greatest difficulties. Often it is that very aspect of TS (and it's associated symptoms/conditions) that physicians will deny exists - a source of much annoyance and exasperation to those afflicted.
