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Road Not Taken

The Road Not Taken

Over the years, I have observed that there is a theorem practiced in most every profession: the Law of Convenience. It is a phenomenon that occurs when authority figures are presented with complex multifaceted situations and expected to remedy them. When their worldviews become overwhelmed with details that create a unique challenge, the authority figures decide that the situation is beyond their comprehension. The easiest way out is to ignore the complexities and just make a judgment that is not in accord with the situation, but is satisfying to authority figures' ego. Attorneys, scientists and physicians alike practice their craft under the enchantment of the Law of Convenience. What is disturbing about the Law of Convenience is that the easy way out is seldom, if ever, the proper or accurate solution.

I recently re-evaluated a patient (Mr. X) who is suffering from profound depression and he is considered to be morbidly obese. He is a kind, gentle and soft spoken soul who is in a dark gray consciousness. He has chronic pain from a rheumatologic disease and suffers from hypertension and sleep apnea. His personal medical biography is complicated by a number of psychosocial stressors, the major one is his son who lives at home and is a neer-do-well. I evaluated Mr. X some time ago and restructured his medications, hormones and food plan. For about one month, he started to see the sun shine again. He was encouraged and optimistic.

Then he was presented with another psychosocial disturbance related to his son and Mr. X fell into the throes of another episode of deep depression. He returned to his gaggle of specialists hoping to find a silver bullet from one of them to reverse all of his symptoms and regain some form of a quality life. His wife, a nurse, was trying desperately to get him to realize that his illness was multifaceted and the remedy needed to be more holistic. He was hesitant to change anything in his personal life because he was afraid that the changes would be all for naught. The changes required discipline. We all know that discipline without joy is mere suffering. And who wants to suffer?

In our re-evaluation he related that when he visited with any of his specialists, each physician narrowed his scope of practice to near needle point focus. Mr. X had so many things out of whack that the specialist refused to grasp his/her role in caring for the all of it. Normally, the specialist evaluates their area of expertise, tells Mr. X that he is fine in their area of specialty and then says something like, "I think your obesity is causing your pain, high blood pressure and depression. If you just eat less, exercise more, your problems will go away. You’re just obese. Obese people have problems." Then the specialist walks away. Mr. X might next see a psychiatrist, and the physician would say, "I think your depression is related to your pain medication. I'm not sure, but if you wean yourself off the pain medication and lose weight, your depression might just go away." Mr. X might next see his cardiologist, "Your heart is in good shape. I think your weight is causing your sleep apnea which leads to high blood pressure and depression. Just eat less, exercise more. When your weight comes off. You'll be much better." I can go on and on, reciting the wisdom of a thousand specialists in his case.

The bottom line: they are all using the Law of Convenience as a device to diffuse their lack of understanding. Their suggestions are irrational but they have a logic which makes their advice sound applicable. These are smooth talking authority figures who have spent years deflecting the complicated, making sure that either their therapy is correct and the other guy is not giving the correct advice or the patient is just plain non-compliant. Either way, the specialist washes his hands at the end of their session.

Mr. X is not the only one I have evaluated for complex medical problems who have been seen by specialists that operate under the Law of Convenience. I have an entire practice built on those wounded souls who find no answers about their illnesses, hear irrational balderdash from physicians and nurse practitioners who are evaluating fifty patients a day, and none of their diagnoses are correct nor are their prescribed treatments are effective. None of their care providers took the time to seriously evaluate their patient. Whatever pops into their heads after thirty seconds of conversation while they're evaluating the patient is what comes out of their mouth. Most of the time their advice is distorted but sounds somewhat logical to an ignorant person.

Once a man presented himself with exhaustion, joint pain, weight loss and scleritis. He had been bedridden for nineteen days. His sclera of his eyes were blood red. He had a rash. He had seen 6 physicians before coming to my office. He was told he had a virus and that someday it would just go away. I diagnosed him with a rare autoimmune disease and sent the information to a rheumatologist, thinking that the rheumatologist would concur.

Instead, the rheumatologist sent him to get his skin biopsied and also referred him to an infectious disease specialist. The rheumatologist told him that he did not have what I thought he had. The rheumatologist wanted to take him off his medications just to see how his disease might progress. Fortunately the patient had more confidence in me than the rheumatologist and stayed on the appropriate treatment. He visited the infectious disease specialist who was baffled, while affirming the diagnosis of viral infection he stated confidently that he did not have the disease of which I diagnosed him. The dermatologist's biopsy proved he had the disease I thought he had.

He was evaluated by nine specialists and generalists, all denying his diagnosis and telling him I was mistaken. It was a complex illness that required thought and mindful research. When they were presented with the skin biopsy results, instead of eating crow they just let the patient know that they never diagnosed and treated a patient with his disease. Point being, perhaps they had and those patients were too complex for them to appreciate. They all operated under the Law of Convenience; Giving irrational diagnoses that were rooted in a narrow outdated medical worldviews which might sound logical when they talk about the patient's illness because their ideas are simple and easy to grasp; But their diagnoses are not remotely Truthful (accurate).

What about Mr. X? He has a decision to make. He has to weigh the consequences of changing the all-of-it verses the consequences of walking the trail of fears guided by specialists who practice under the Law of Convenience. He is at a fork in the road.

Perhaps he should read the poem by Robert Frost: The Road Not Taken.

Doc
Posted by Amanda Sanders at 12:21 PM
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