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People have a tough time being sick or ill for any prolonged length of time. I would like to perform a study to calculate the average duration of illness patients had before they decided to come to the Stone. I believe it will be roughly two years or more.

In that two years span of time, they have typically seen a multitude of physicians and specialists of all kinds, have had numerous studies performed and have been prescribed at least ten medications, most of which do nothing to soothe their symptoms. The most disturbing aspect of their illness is that they believe their physicians seldom listen to their complaints, even though they visit their doctors every three months or so.

When I read the medical records of the patients from other doctor's offices, I find most of the physician notes are computer generated. Sometimes one visit to the physician is recorded in eight pages or more of notes with little or no narrative about the patient's history. The record is primarily boilerplate language used on most patients printed on some sort of computer-generated stationary. While I sit and speak to patients for prolonged periods of time, I can generate at best two pages of handwritten notes while in their presence. The computer generates lengthy medical record based on a number of algorithms which are preprogrammed. All the physician or physician extender has to do is type in a brief narrative and push a button. Eight pages of worthless information is created and authenticated.

So what? Medical records are important for any number of reasons. In a typical medical office, insurance reimbursement strategies are created for maximum financial recovery from insurance companies. Upcoding is often times computer generated so that a physician can maximize their billing by adding one more tests to prove it was a complicated medical problem or showing that they spent more time with their patient. When I ask a patient how long their physician spent with them and they reply five minutes and they did not touch me, it becomes apparent that the physical the physician allegedly performed was not done, nor was the lengthy twenty-minute face to face activity noted on the medical record.

A fortyish-year-old woman came to my office last week accompanied by her twin sister. I was shocked at the difference in their appearances. The ill twin had lost about sixty or seventy pounds which altered her appearance significantly from her more healthy sister. Prior to coming to my office, the ill twin had been sick for two years and had seen numerous physicians in the Memphis area as well as a ten-day visit to Mayo clinic. I had computer generated physician records from a few of her physicians and the Mayo Clinic; the only valuable information they contained was laboratory data. During her ten-day visit to Mayo Clinic, she was evaluated by at least ten physicians on a very timely schedule, but the medical record contained very little about the Bayesian activity that went into making her diagnosis.

Bayesian statistics are used to create and pair down a differential diagnosis to the actual disease, if possible. The process is named for Thomas Bayes (1701–1761), who established a theory in the field of statistics in which the evidence about the true state of the world is expressed in terms of degrees of belief known as Bayesian probabilities. In the practice of medicine, a physician is supposed to create a list of all the diseases that could possibly fit the patient's symptom complex. Each disease or syndrome is entertained as long as the clinical data supports or refutes it. Diagnosing disease is a process of elimination. Every diagnosis is only one of a number of diagnoses base on probability and there are other statistical techniques that are not based on 'degrees of belief'. One of the key ideas of Bayesian statistics is that "probability is orderly opinion," and that inference from data is nothing other than the revision of such opinion in the light of relevant new information. Doctors are supposed to keep an open mind to all possible illnesses and revise their opinion as the new clinical information arrives. However, once patients are labeled with an illness, most physicians seldom entertain the idea that the diagnosis was in error. 

Back to our patient. After a rigorous evaluation at the Mayo Clinic, it was determined the patient had fibromyalgia. She was sent to the Fibromyalgia Clinic where she sat through sixteen hours of educational classes about Fibromyalgia. She said it was very informative. She returned to Memphis with the idea that she could control her illness if she followed the Mayo Clinic care guidelines for Fibromyalgia.

Unfortunately, her illness took a turn for the worse within a few days of the Mayo Clinic adventure. She developed projectile vomiting and diarrhea for ten weeks and lost down to ninety pounds. No medicine could curb her body's desire to vomit nor did it stop her colonic emptying. When I saw her, she was about three weeks removed from the ten-week experience. She looked at me when I asked her how she got her gut to simmer down, "I don't know. It just stopped." Clearly, she does not have Fibromyalgia as her underlying illness.

One of the hallmarks of her illness is that it began after a three-month episode of pneumonia that was resistant to antibiotic treatment. Her mother was fading away due to early onset dementia and her boss was treating her like a rented mule. The stress in her life was off the charts which probably made her recovery from pneumonia difficult, if not almost impossible. When her illness took hold, she spiraled downward. She hasn't recovered since.

I believe she is suffering from some kind of auto-immune disease with many different manifestations. She has some testing to support my theory. I haven't labeled the illness yet since we are early in her care. Keeping an open mind to the possibilities of her condition is key to the success of her therapy. I have no doubt that she will get better and find a new way to live her life, much different than the past two years. I also think her fibromyalgia will disappear when the underlying conditions are relieved. She may have buyer's remorse related to the Mayo Clinic adventure, but she cannot go back and change anything. At least she can rest assured that her illness remains a mystery and her medications so far have little benefit to her.

Her computerized medical record looks like the old 1997 Funk and Wagnalls New Encyclopedia, the difference between the two is that there was more information contained in the encyclopedia than in her medical record. So far, her physicians are hanging their hats on a few pieces of esoteric clinical laboratory data and not looking at the picture as a whole. Lupus is their next best guess although Mayo physicians disagree (me too). Her medications are not in agreement with her diagnosis and seem to cause many of her symptoms. There is no communication between her physicians what-so-ever. Perhaps each doctor is afraid of infringing on the others expertise and at the same time, each one is adding prescriptions that adversely interact with other therapies without improving her medical condition. She looked around at one point and just gave up. Her twin sister has not.

What's a person to do? Get off the Merry-Go-Round. Stop the Madness of a disturbed medical system. And Heal. The rest will be history.

Doc

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