The Death of the Diagnosis
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?