Archive for the ‘medical diagnosis’ Category

What’s My Diagnosis, Doc?

Tuesday, September 25th, 2007

Just because your doctor has a name for your condition
doesn’t mean he knows what it is.

Six Principles for Patients
Murphy’s Law, Book 2

More than 1.2 billion patient visits to U.S. physicians, hospitals, and ER’s in the past year were recently analyzed in the latest NCHS report of August 2007 . If you discount re-visits, chronic illness, routine follow-up, preventive, and visits for injuries, and poisonings, 75% did so because of a symptom or specific complaint(s). A vast medical literature indicates that certain complaints, often described as “unexplained” are exceedingly common in the general population.

Large studies have shown that up to 80% or more of all healthy people (including you and me, Dear Reader) experience at one time or another a virtual mixed salad of unexplained bodily symptoms. Among the most common ingredients are: fatigue, weakness, irritability, faintness or dizziness, atypical headaches, an endless variety of joint and muscle pains, nasal congestion, insomnia, sleepiness, brief tinnitus, unexplained attacks of itching, transient weight loss, nausea, constipation, diarrhea, sweating, etc. The list is virtually endless. What most of these complaints have in common is their strange unprovoked, and often short-lived appearance, their anatomic inconsistencies, their failure to conform to any well-defined syndromes or disease entities, and most important of all, their usually benign clinical course. Persistent or recurrent flavors of these and other complaints fall under the veil of psychiatric illness, but most of us are not “emotionally challenged.”

What Indeed is in a Name, Juliet?

Seeking diagnostic perfection, doctors and patients alike feel comfort in the delusional certitude that naming is knowing and knowing is curing. Yet by the overwhelming need to give a name to every clinical presentation doctors as well as patients are the cause of much medical mischief. Among those of us who constantly visit doctors with unexplained physical complaints, many are unhappy or dissatisfied with their physicians. An increasingly large number of these patients are subjected to extensive “workups,” needless, often expensive, even dangerous testing, multiple physician visits, consultations, and “doctor shopping.” Some fear they have cancer or some other potentially fatal illness. Others regard a referral to a psychiatrist as dismissive of their concerns.

As I have mentioned in a previous Second Opinions Newsletter, “…It is possible, as many psychiatrists observe, that neurotics more often tend to feel problems in their bodies rather than in their psyches, but overwhelmingly, we are all of us susceptible to unexplained somatic complaints. As observing clinicians gradually learn, (though are almost never taught) do not to take everything too seriously too soon. This requires a sixth sense for the significant.

A seasoned and wise clinician, when confronted with banal complaints, or even the bizarre or clinically unexplainable, in an obviously well patient, should be able to say, “We see this; it will go away.”

P.S. All I seem to be getting lately is spam disguised as “comments.” How about some genuine comments?