The art of medicine

Doctors often spend time looking for medical conditions that are treatable.  For instance, a patient who is diagnosed with an acute bacterial pneumonia has myriad findings that correspond with this diagnosis, including the preceding symptoms, physical findings, radiographic findings and less commonly a positive sputum culture.  Although we do not always have a conclusive diagnosis, we have enough information to treat the process with empirical antibiotics.

Sometimes with chronic conditions, we don’t acknowledge that it may be causing a problem until it can no longer be denied.  The same is with regards to obesity – the health effects worsen with the degree.  Earlier on, a person may note a feeling of fatigue, swelling in the legs, worsening heartburn or sleeping problems.  He or she may wonder if they have chronic fatigue syndrome, because they are not feeling as much energy during the daytime. 

As is common with chronic conditions, people may take medications that treat the symptoms and delay medical visits.  They may consult naturopaths, chiropractors or acupuncturists with these concerns and be given different treatment options, sometimes not addressing the association with their weight and their health.  Terms like fibromyalgia, chronic fatigue syndrome, “adrenal fatigue”, or even chronic Lyme disease may be brought up during these visits, without realizing the process may be linked to their obesity or other behaviors.  Sometimes, clinicians may enable these concerns without doing any major work-up of conditions that can present similarly.  Many times patients will have limited benefits or be informed that “treatment options may take several months”, only to end up back to the problems that they hadn’t had fully addressed in the first place.

Not only are patients seeking information with other clinicians, they are also seeking out information online.  Information has become more available at an alarming rate.  In the past twenty years, literature that was once only available in specific libraries is now available at the click of a button or swipe of the finger on personal computers or cellphones.  The transition has not been without its growing pains.  With the information comes sifting through material that could be a source of bias or change the emphasis of evaluation.   By searching a diagnosis and checking symptoms, the process of determining a potential issue can be driven in reverse, an attempt to rule out the concern.  What would be ideal is that a process is identified before it becomes more severe and leads to more, potentially irreversible or life-threatening damage.

Although there are information databases that allow one to list out their symptoms and provide a possible diagnosis with statistical likelihood, it hasn’t replaced the job of a physician, who has been trained to sift through information on history and physical examination and work toward a greater understanding of the health issues.  Even this training has its shortcomings as it manifests in the modern age of medicine.  Tests have sometimes usurped the decision-making skills of a physician and can sometimes send a patient on a roller coaster of anxiety and stress while a process, possibly discovered incidentally on one test, obligates a physician to order further tests.  This is compounded by the fact that the average patient visit has decreased to around 10-15 minutes a visit, which is seldom enough time for the patient to work through his/her concerns, or a physician to review and truly understand how the patient’s complaints related to an underlying condition.

Sometimes by spending more time with a patient can be useful to develop a rapport with the patient and open a bridge of communication that sometimes leads to more informed decision-making.  A patient and physician can come up with an agreement of time points and concerns for further testing and monitor the process through time.  Sometimes it provides reassurance that it is being evaluated through time, and allays the fears that came up from self-searching online.  In some cases, asking the patient what is their reason of coming in – or major underlying motivator- of health seeking behavior can be a good way to explore their condition and interact with the patient toward the goal of understanding the condition.