Medicine is asking all the wrong questions, and we’ve been programmed to follow along and ask those same wrong questions when it comes to our health. The whole situation reminds me of a scene from Moneyball where Johan Hill’s character Peter Brand is explaining what’s wrong with the way baseball players are being managed and selected to Brad Pitt’s character Billy Beane (see below for video). Read more
It is the holy grail of medicine – the diagnosis. TV shows like ‘House‘ were based upon finding the correct diagnosis in dramatic and somewhat unrealistic fashion, as it is the only way to move forward and treat the patient. Doctors find a diagnosis, and only then can they construct a plan of action to bring you back to health. And while this approach of diagnosis first and then a generalized treatment has worked for quite some time, does it have merit in the 21st century where we have seen an explosion of complex and chronic conditions?
I recently had the pleasure of speaking with an internist who specialized in undiagnosed patients and is part of NIH’s Undiagnosed Diseases Program. These patients are passed along from physician to physician, specialist to specialist, yet they are not treated for their health problems because a definitive diagnosis cannot be determined. The symptoms are real – the discomfort and agony are real – but for whatever the reason, a diagnosis is impossible. And without the all-mighty diagnosis, nothing can be done for these patients. They drift along hoping that someone will give them a diagnosis, so they can then begin their treatment and hopefully alleviate some of their symptoms. That’s just how important the diagnosis has become.Research shows women are more likely to wait longer for a health diagnosis and to be told it’s ‘all in their heads’. That can be lethal: diagnostic errors cause 40,000-80,000 deaths in the US alone.
So why the title “The Death of the Diagnosis“? Because, for all we know about the human being and that we are not machines, but truly unique individuals, the diagnosis means nothing! It’s a bold statement that most doctors would cringe at, but it’s one that a growing number of open-minded physicians are beginning to embrace. Let me explain why.
A patient arrives to a doctor’s office with the following complaints: headache, fatigue, poor memory, loss of concentration, minor gastrointestinal complaints, depressive mood, and some general pain in the joints and lower back. And to be honest, those are most likely just the main symptoms that the patient could come up with at the time. Maybe they also have some pains in the gums from time to time, or slight muscle twitches that they dismissed as a post-workout spasm, and have no relevance to this evaluation. The stressful work situation they are in also doesn’t have much to do with this health problem, or does it? Did they mention the diet of fried and processed foods mostly eaten late at night? Or the fact they work around some chemical solvents from time to time? Or that their father-in-law is battling cancer and it has put strain on their relationship with their partner? Probably not.
Nevertheless, the doctor has his symptoms. He runs the tests, and according to the blood work, his own history/knowledge and physical evaluation, and the patient’s limited statements, a diagnosis is provided. Perhaps the doctor identified an infection in the body, or that the symptoms alone allowed the doctor to deduce what is the probable culprit. A generalized, blanket protocol that is the accepted treatment plan for the said diagnosis is given, and a wait-and-see approach is taken with the hopes of symptom resolution. Sometimes there is resolution, other times there is not. And if there isn’t resolution, we either go with plan B in generalized treatments for the diagnosis, or try and re-diagnose and give that a shot.
The fact remains, a diagnosis will never take into consideration the truly unique and personal issues that affect each and every one of us differently. The diagnosis will never address the stress one receives from a dysfunctional relationship; from the reaction an artificial preservative in a certain food we ate has on our large intestines’ absorption rate; from a chemical in a lotion we use daily that over time has compounded in one’s connective tissue and only after several years of use is exhibiting in a symptomatic manner. The diagnosis assumes we all live in a vacuum – that we all react the same to stimuli and endure the same stimuli.
The reality is, the magnitude of compounding detrimental factors that affect the average human being today has rendered the diagnosis pretty much useless. The modern day physician must be able to identify all areas of dysfunction, all root causes of imbalances in the body (whether biochemical, psycho-emotional, or even spiritual) and create a personalized plan of treatment that can efficiently address these areas. The good news is, with the growing prominence of functional medicine (a step in the right direction) and more advanced personalized approaches such as the one we advocate at Innovative Medicine, we can begin to move past the diagnosis and truly tailor treatments to each patient and with a wide range of options spanning many different therapeutic modalities.
“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
Sir William Osler
Founding Professor at John Hopkins Medicine
The diagnosis is dead. It may be a hard pill to swallow, since as human beings, we love to label everything. But for medicine to progress and reverse the rising rates of chronic illness, we have to move past this mentality, and realize that we are all so different and distinctive. Shouldn’t our treatments and plans to restore health reflect this truth?
Symptoms are not treatable. Yes, you heard me right. Symptoms are not treatable. Why do I say this? Because you can’t treat a leak in your wall by replacing the wall – you need to figure why it’s there in the first place and fix that. Let me explain.
I recently had a water leak problem in my bathroom. One day after a long shower, I noticed that when I stepped on the tiles floors right outside the shower, they made a slight squishing sound. ‘Not good‘ I thought. I called up the superintendent, and the first thing he did was bring in a vacuum to help dry the tiles. They put the nozzle right at the point of grout between the tiles where the most water could be heard making that squishing sound when you stepped on it. A porter held an industrial vacuum at this junction for 15 minutes with very little effect. The tile was still squishing when you stepped on it. Next thing the super did was try and find the cause. He began at the sink, turning it on full blast and looking at the connections under the sink. All looked well. Next, the toilet. He flushed a number of times in a row and inspected the toilet and surrounding area meticulously on his knees, and saw nothing wrong there. So he moved on to the shower – the main suspect now that the other 2 checked out. He turned the shower on, looked at the spigot, the shower head, etc. He finally said that it did not look like anything was wrong, but noticed the caulk where the bathtub met the tiled wall seemed cracked, and water may be seeping in under the tub and settling under the tiles. Didn’t seem like a great explanation, but plausible. So the next day he re-caulked the whole area, and all looked well.
Unfortunately, all was not well. A week later I had a friend stay over and we took back to back showers, and lo-and-behold, the squishing tiles returned. Caulk still perfectly white and intact, but tiles wet underneath. The superintendent seemed a bit baffled, but noticed some minimal water damage near the entrance of the shower, between the bathtub and sink. “Ahhh, it must be that water is leaking around your shower curtain and dripping down the side here” he told me with a proud smile like he was Sherlock Holmes and just cracked the murder case. At this point, I was almost sure he was wrong, but had no other recourse. I bought a plastic shower guard that connects from the edge of the bathtub to the tiled wall where he believed water was leaking around my shower curtain. It was a special extra-large one – not pretty – but I didn’t want to take any chances. We installed it to ensure no water would be leaking from that corner. All seemed well afterwards and whenever I bumped into the super in the hallways, he would gloat and say “I told you it was the water leaking in the corner of that bathtub.” If only it was.
“If your only tool is a hammer then every problem looks like a nail.”
— Abraham Maslow
A few weeks later after a morning shower, I stepped out of the bathtub and the dreaded sound was heard – the squish was back! To make a long story shorter (this isn’t a post on plumbing), the super had to call in a plumber and they had to look behind the walls. Turned out it was a faulty pipe connection. While a simple shower wasn’t enough water leakage to cause the tiles to squish, if someone took a prolonged shower (like 2 in a row) or the neighbor showered at the same time, enough water would leak to cause the squish in the tiles. Over a month after the initial problem and after a good amount of trial-and-error plus a large hole in my bathroom wall, and the problem was solved.
Now, to the point of the leaky pipe case – you cannot solve a problem (faulty water pipe, disease, illness, health issue, etc) without looking at the SOURCE. The squishy tile was a SYMPTOM. When my superintendent treated the symptom with re-caulking and replacing some external parts, he did achieve some relief from the symptoms, but he did not correct the problem. This is the same in medicine and health. If we treat symptoms, we may achieve what we believe is success and those symptoms may diminish or even disappear, but the source problem will still be there and those symptoms will either return at some point, or express themselves in a different way.
In the case above, my super may have continued to treat the symptom and performed “surgery” on the tiles, replaced them with new ones that somehow do not allow water to get under them and will never squish, and that would probably have worked – for a while. Sooner or later, that leaky pipe would continue to leak water, and although the new special tiles wouldn’t squish anymore, the water from the leaky pipe may travel and collect under the wood floors the next room over. Not only would this damage the wood, it may also cause toxic mold, and thus not only call for total replacement of my wood floors, but also for treatment on my new respiratory problem caused by unseen toxic mold spores. Suddenly a little leaky pipe becomes a total home renovation and a trip to the hospital.
We see this all the time in medicine. We try and treat symptoms by suppressing them with drugs, medications and surgery, only to find a completely different illness has arose years later. Normally we don’t correlate the two, and little explanation is given over why this new, usually worst, illness has come up. A patient who treated their hypertension with anti-hypertensive drugs controls their high blood pressure, but after years of using these suppressing drugs they are diagnosed with pancreatic cancer. Everyone reacts differently, so the suppression of a symptom may be completely different case-to-case. But one thing is for sure, you cannot treat symptoms.
Side note: In acute cases, you may be looking to relieve your symptoms with OTC medications. This is fine, but this is not treatment. It’s your immune system that does the treating in your body in acute cases, such as a common cold. It’s always better to have a strong immune system rather than rely on medications that relieve symptoms. The immune system is smart enough to go after the source in a healthy person with an acute case.
Truth bomb: I was born with a hole in my heart. A ventricular septal defect to be exact. While not a huge concern for most (it is one of the most common congenital heart defects), my hole was large enough to give cardiologists and my parents a scare. Some would say that this is unfortunate, or unlucky, but I disagree.
I still remember receiving echocardiograms at an early age, thinking this was something normal for all children. My parents never coddled me or gave in to the numerous cardiologist’s beliefs that I would not be able to participate in strenuous activity. And while they chose not to agree with those cardiologists who wrote me off from a very early age, they took numerous steps to ensure I was living a very healthy life from an early age and instilled in me that nothing was wrong. It was because of this that I attribute the closing of my hole and saying good-bye to that ventricular septal defect by the time I was 7. The cardiologists couldn’t explain it. And suddenly, I wasn’t unlucky, but rather seen as ‘lucky’ and a ‘special case’.
“Luck is what we make it, not what is thrust upon us. You’ve shown initiative and it has nothing to do with luck.”
– George Bellairs
I don’t buy it. There is no “luck” in health. None of us live perfectly healthy lives, and we all have to deal with problems related to our health. But the difference between the person who sees themselves as unlucky and those who choose to take on this problem and see it as an opportunity to improve will make all the difference in the world. Luck is defined as “success or failure apparently brought by chance rather than through one’s own actions.” Once we tell ourselves that we are lucky or unlucky, we become victims. We tell our mind that we have no power to change the outcome of our health. It’s unfortunate that modern conventional doctors often contribute to this feeling of becoming “unlucky” and victimizing many people with health issues. I’ve studied hundreds, if not thousands, of medical cases where patients were written off with chronic diseases with no known cure, only to be provided another nonconventional option and become perfectly healthy. Were these numerous cases all lucky? No, they expanded their awareness, researched their options, and found a way back to health. Was it easy? No. But many of these patients can contribute the struggle back to health to a greater gratitude for life and often realize the struggle was necessary to get to a higher place in their life. They chose not to become unlucky victims, but rather empowered people who are now much better prepared for any adversity.
The human body is remarkable, and has the capacity to heal itself to the extent that even modern science cannot explain many instances of people overcoming “incurable” conditions and diseases. As for me, the kid with a big hole in his heart – I went on to climb three of the Seven Summitrs (highest peaks on all 7 continents), participated in mini-marathons, played football, baseball, tennis and soccer at an early age, and never had any of the cardiovascular problems that are common for those who suffer from a large ventricular septal defect. When people tell me how lucky I am that I am healthy, I don’t tell them how I was an “unlucky” baby, but rather smile and politely thank them. I understand how fortunate I am to have my health, and am very grateful, but luck’s got nothing to do with it.