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Diagnosis and Treatment: Drive Your Own Bus

How many times have I heard the question: “Why didn’t my doctor find these problems?” I have been asked this question not hundreds, but probably thousands of times over the last 30 years of practicing medicine. Patients are dumbfounded by a medical system that appears to produce physicians, physician’s assistants and nurse practitioners who consistently seem inept at diagnosing and treating illnesses. It’s not that these care givers are ignorant, quite the contrary since they have weathered many years of rigorous training and education, passed multiple examinations to prove their knowledge base, and take continuing medical education courses on a regular basis to maintain a current license.  

What is missing? They have a very narrow worldview of what constitutes being a doctor, and they have a very narrow skill set. Most physicians today do not look at the root of illness, just the illness itself. Finding the root of a disease is reserved for researchers and non-physician epidemiologists. Based on a set of symptoms, once physicians diagnose a disease and attach a name to it, they have a number of pharmaceutical treatment options from which to choose. All humans possess a great compassion for righteousness, so most physicians stand firm in their diagnosis even if it is blatantly wrong. That does not bode well for the infirm.  

Having a narrow focus, being unable to find root causes, and possessing righteousness are three serious factors related to the lack of understanding of the ill. Our medical system has splintered into a group of disconnected specialists largely because of profiteering, falsely marketed as increased efficiency and accuracy. Simply stated, a specialist on average makes a lot more money than a generalist. Specialists and subspecialists have significantly narrowed their scope of practice and disease management to enhance the use of protocols and standardized medicines. This allows them to evaluate and treat large (through puts) volumes of patients in a relatively short time. Because they have a narrow window of vision, if they decide that you don’t have symptoms related to a disease that they treat, they will refer you to the next specialist down the line. It’s a case of pass the hot potato until someone gets it right; or everyone gets it wrong, and you end up in a psychiatrist’s office thinking that you are crazy. Any illness can look like any other illness; they are all great impostors. The greatest rule of most specialists, and generalists alike, is that if someone doesn’t look ill, they can’t be ill. That means if a woman puts on makeup to see a physician, she is more than likely faking it. So not true. If a woman doesn’t put on make up to see a physician, she’s probably on her deathbed.  

Most diseases are either a classic example of a rare illness or an odd presentation of a common one. Specialists tend to look for the most common form of an illness. Therefore, most patients are misdiagnosed and over or under treated. Assigning a patient to a treatable disease category is almost a random event; it’s just as likely that someone will be placed in a non-treatable category since most presentations of an illness are mysterious. Most physicians lack sufficient time to find root causes, and almost all of them avoid the difficult task of finding the trigger of a disease. Constantly mislead by the news media and television series, patients believe that doctors are taught to look for the root cause of disease. The show “House” is just a show. Dr. House doesn’t exist. It is rational and logical to believe that if the root cause of a symptom is discovered, then adjusting or eradicating the problem will alleviate the disturbance. That is true only in rare cases where the disease has a single associated disturbance. Most diseases are a result of multiple disruptions at one time. Consequently, having a narrow scope limits a physician’s ability to see something other than what they expect to see; and that eliminates any possibility of finding a root cause other than what they expect. How many non-ischemic heart attacks go undetected because the patient has no blood clot in their arteries? Now you see what I mean.  

Most physicians, like most Americans, possess vertical thinking. That means that they build their most complex thoughts on a foundation of simpler thoughts. And in the end, they cannot change their foundational thoughts or their entire tower of ideas will come tumbling down. That’s what I mean by righteousness. Physicians have a righteousness that does not allow them to look for anything other than what they believe. They are no different than any other human for that matter. Even when a generalist, or a specialist, has correctly diagnosed a patient, and refers the patient appropriately, many times the new specialist will refute the current correct diagnosis and assume another one in an effort to show they have the superior intellect, even if their diagnosis is wrong. The clinical data may support the correct diagnosis of the generalist; but the specialist knows best. This righteousness is common, and many times, it leads patients into unnecessary procedures and surgeries. But the specialist physician makes money and affirms their ego; the patient doesn’t matter at that point.  

My advice is relatively simply, own your illness. The internet has many flaws, but it also has many gifts, one of them is medical reference material. In the old days, I had all the knowledge and the average person couldn’t get access to any of it. The information was in books that were in medical libraries and in esoteric medical journals. Now they are all online. Know your diagnosis before you see a specialist. A generalist can usually find enough information via blood testing to eliminate the most common illnesses. Do not allow a generalist to send you to the wolves for diagnosis; instead see the specialists for consultations concerning possible treatment modalities for your stated illness. Then return to your generalist to see which one is best for you given your set of circumstances. It might be difficult to find a generalist who will take the time to find out what’s wrong, but it’s worth the effort in every way.

Physicians may give you advice about the road to take while you are on a therapeutic adventure, but most times, there is more than one road leading to the same destiny. Since you’re in charge of driving your bus, it is best not to take too many wrong turns on your way to wellness, because you just might get lost in never-never land. And that’s never a good thing, ever. Enjoy the ride as best you can.  

Doc      

Posted by Katie Reed at 8:21 AM
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