Does a diagnosis explain what's wrong with you?

What does your diagnosis tell you?

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When you go to the doctor and he gives you a diagnosis, how do you know what’s wrong with you?  A diagnosis is a name given to a constellation of symptoms, but it doesn’t tell you what’s causing them. So argues, Dr. TJ Williams, in an article written for The Healthy Planet, saying that the belief that a diagnosis does tell you what's wrong is the greatest obstacle to better health.

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Many people mistakenly believe that if you know the name of your disease, you know what’s wrong with you. This myth is pervasive throughout medicine, and it is THE single biggest obstacle to changing the way we do things and finding the answers to our health problems.

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The problem, he continues, is that doctors have been trained to prescribe medication or treatment based on the name of the disease they diagnosed. 

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It is what most doctors have been trained to do. Find the name of the “disease,” then match the drug/treatment to the disease. You have “depression,” so you need an “antidepressant.” You are “anxious;” you need an “anti-anxiety” medication. You have bipolar disease or mood swings, so you need a “mood stabilizer.”‍

Diagnosed with Alzheimer’s but it wasn’t

Dr. Mark Hyman and Dr. Mark Liponis wrote about this problem in their book Ultraprevention (pp. 52 - 53). They described the case of Jerry, a sixty-eight-year-old man who had been diagnosed with Alzheimer’s. He and his wife Dorothy came to their clinic to find out if there was anything they could do and what symptoms they could expect in the future.   

Listening to Jerry, they began to suspect that he may not have Alzheimer’s but mercury poisoning since he had many silver fillings and ate a lot of fish known for being high in mercury.  

[W]e indeed discovered Jerry had the highest levels of anyone we’d ever tested. We went forward with our treatment (which required intensive mercury-elimination therapy). Within six months, Jerry’s mercury levels had dropped significantly and his mental functioning had improved.

Jerry and Dorothy were convinced that because Jerry had been diagnosed with Alzheimer’s disease he was going [to] be sick for the rest of his life. But here’s something you must remember for the rest of your life: Just because you’ve been told you have a certain disease doesn’t mean you know the cause. (Emphasis added.)

Drugs and polypharmacy can cause dementia

Dementia can also be the adverse effect of several different drugs, as Maria Zhang reported for Principia-Scientific.

Several drugs increase the risks of dementia, the most prominent being anticholinergic drugs, anti-epileptics, oncology drugs, and sedative-hypnotic drugs. These are all common prescriptions for older people.

Polypharmacy increases the risk of PIM administration, and as some PIMs may have cognition-impairing effects, prolonged polypharmacy may result in dementia. Therefore, efforts are needed to limit or decrease the prescription of medications that have been associated with risk of dementia in the elderly.

When the thinking stops

Hyman and Liponis explain that usually when a doctor gives a diagnosis neither he nor the patient generally gives a thought to the underlying cause.

[T]raditionally, once your symptoms have been given a diagnosis, the thought process stops. Neither you nor your doctor have to think anymore. He looks in the recipe book to find a treatment for your disease and tells you what you should do; you, in turn, take a drug that suppresses your symptoms.

‍We think that the moment you receive a diagnosis is when the thought process should start. Doctors should begin asking themselves: Why does this person have asthma? Why is this person depressed? Is there something  causing this collection of symptoms that we can target?

The differential diagnosis, or the diagnosis that tells the patient in a few words what is wrong, is the equivalent of the Holy Grail in Western medicine. When the doctor makes that diagnosis, the doctor is king. It’s like winning a game of medical Jeopardy.

Are quick doctors' appointments part of the problem?

Part of the problem may be the quick 10 minutes or so that patients have to meet with a doctor, in which time they have to explain their symptoms and the doctor has to figure out what is wrong and write a prescription.

‍Forbes Magazine recognized the shortcomings of even a 15-minute appointment. Senior contributor Dr. Bruce Y. Lee sarcastically suggested that doctors and patients should dispense with formalities among other things, in order to make the most of the time available.

‍[A]s indicated in a recently published study in the Annals of Internal Medicine, doctors aren't even spending the entire 15 minutes talking to and examining patients. The study, led by Christine Sinsky, MD, at the American Medical Association, found that even when in the examination room with patients, doctors were spending only 52.9% of the time talking to or examining the patients and 37.0% doing paperwork. In other words, shrink that 15 minutes to under eight minutes (or the same amount of time women spend sitting on toilets a day, because apparently women are more efficient on the can).

Does eight minutes even make sense? Let's examine a typical visit and see how you can squeeze everything needed into eight minutes. The visit begins with the doctor opening the door and saying hello. This can probably take under a minute as long as you, as the doctor, don't shake hands too long and make any social greetings that require a long answer such as "enjoying the weather", "have trouble finding parking" or "how's the family". Also, make sure that the patient understands and speaks English fluently, because any type of miscommunication or translation may require more than a minute. And patients, don't talk to the doctor, which wastes time. Just say "hello" and smile.

The doctor who aims to rid patients of disease

Dr. Rangan Chaterjee is a UK medical doctor who looks for the cause of symptoms. Watch him in this Ted X talk as he explains how five and a half years prior his little son nearly dying from low blood calcium caused by a vitamin D deficiency set him on a path to learning how to heal, not just diagnose.