Why the Diagnosis is Overrated

07
Apr
2017

It is the holy grail of medicine – the diagnosis. TV shows like ‘House‘ were based upon finding the correct diagnosis in dramatic and somewhat unrealistic fashion, as it is the only way to move forward and treat the patient. Doctors find a diagnosis, and only then can they construct a plan of action to bring you back to health. And while this approach of diagnosis followed by generalized treatment has worked for quite some time, does it have merit in the 21st century where we have seen an explosion of complex and chronic conditions?

The All-Mighty Diagnosis

I recently had the pleasure of speaking with an internist who specialized in undiagnosed patients and is part of NIH’s ‘Undiagnosed Diseases Program’. These patients are passed along from physician to physician, specialist to specialist, yet they are not treated for their health problems because a definitive diagnosis cannot be determined. The symptoms are real – the discomfort and agony are real – but for whatever the reason, a diagnosis is impossible. And without the all-mighty diagnosis, nothing can be done for these patients. They drift along hoping that someone will give them a diagnosis, so they can then begin their treatment and hopefully alleviate some of their symptoms. That’s just how important the diagnosis has become in medicine.

The Problem with Relying Solely on a Diagnosis

While every medical student is drilled in the importance of reaching a correct diagnosis, there are several limitations and problems to relying solely on a diagnosis for successful treatment.

  • Misdiagnosis – Each year in the U.S., approximately 12 million adults who seek outpatient medical care are misdiagnosed, according to a new study published in the journal BMJ Quality & Safety. This figure amounts to 1 out of 20 adult patients, and researchers say in half of those cases, the misdiagnosis has the potential to result in severe harm.
  • Differing Diagnoses from Different Practitioners – The investigation, published online in the Journal of Evaluation in Clinical Practice, found that 88% of patients who came to the medical institute for a second opinion, left with a different medical determination. The study team, led by James Naessens, a Mayo Clinic health care policy researcher, compared the referring diagnosis to the final diagnosis. In 21% of the cases, patients got a completely different diagnosis, while around two-thirds of patients got a modified diagnosis. For 12%, the diagnosis remained unchanged.
  • Failure to Address Underlying Causes – One of the greatest downfalls of a diagnosis is the inability to answer the question, “why do I have {diagnosis X}?” To group large amounts of people into a treatment protocol by diagnosis without addressing the differences of why they have their health issues is quite shortsighted. While one patient’s hypertension may be caused by stress, another patient’s hypertension may be caused by diet and genetics. To treat them the same does nothing to address their underlying causes and unique needs.

“A diagnosis is a name given to a constellation of symptoms that present themselves in unhealthy individuals. While a diagnosis can be critical in many acute conditions where life or death decisions need to be made based on correctly identifying the causative agent, it proves less valuable in chronic illness where the causes are multifactorial and multidimensional, and where a diagnosis often can blind the practitioner to addressing all the underlying root factors that lead to chronic illness. This is where a truly powerful integrative approach that addresses the myriad of factors that underly our long term health needs to be employed in order to heal chronic illness and truly bring back balance and wellbeing.”

– Mark Iwanicki, ND, LAc

For all we know about the human being and that we are not machines, but truly unique individuals, the diagnosis means very little! It’s a bold statement that most doctors would cringe at, but it’s one that a growing number of open-minded physicians are beginning to embrace. Let’s explain why.

An Example

A patient arrives to a doctor’s office with the following complaints: headache, fatigue, poor memory, loss of concentration, minor gastrointestinal complaints, depressive mood, and some general pain in the joints and lower back. And to be honest, those are most likely just the main symptoms that the patient could come up with at the time. Maybe they also have some pains in the gums from time to time, or slight muscle twitches that they dismissed as a post-workout spasm, but feel that is may have no relevance to this particular evaluation (a study revealed that 13 percent of patients withhold information from their providers because of privacy or security fears). The stressful work situation they are in also doesn’t have much to do with this health problem, does it? Or the diet of mostly processed foods? Or the fact they work around some chemical solvents from time to time? Or that their father-in-law is battling cancer and it has put an emotional strain on their relationship with their partner?

Nevertheless, the doctor has his symptoms. He runs the tests, and according to the blood work, his own history and physical evaluation, and the patient’s statements, a diagnosis is provided. Perhaps the doctor identified an infection in the body, or that the symptoms alone allowed the doctor to deduce what is the probable culprit. A generalized, blanket protocol that is the accepted treatment plan for the said diagnosis is given, and a wait-and-see approach is taken with the hopes of symptom resolution. Sometimes there is resolution, other times there isn’t. And if there isn’t resolution, we either go with plan B in generalized treatments for the diagnosis, or try and re-diagnose and give that a shot.

The fact remains, a diagnosis will never take into consideration the truly unique and personal issues that affect each and every one of us differently. The diagnosis will never address the stress one receives from a dysfunctional relationship; from the reaction a artificial preservative in a certain food we ate has on our large intestines absorption rate; from a chemical in a lotion we use daily that over time has compounded in one’s connective tissue and only after several years of use is exhibiting in a symptomatic manner. The diagnosis assumes we all live in a vacuum – that we all react the same to stimuli and endure the same stimuli.

Replacing the Diagnosis with….Personalized Medicine

The reality is, the magnitude of compounding detrimental factors that affect the average human being today has rendered the diagnosis ineffective. So what should replace the diagnosis? The modern day physician must be able to identify all areas of dysfunction, all root causes of imbalances in the body (whether biochemical, psycho-emotional, or even spiritual) and create a personalized plan of treatment that can efficiently address these areas.

This is precisely the basis of Innovative Medicine’s approach. By accurately identifying all possible causes of any illness, and combining a great number of therapeutic options that are tested to be compatible for the individual patient, we move past generalized protocols based on diagnosis, and create personalized treatments based on causative agents and rectifying the problem at it’s source. It is the level of personalization that allows us today to forego diagnosis as the determining factor of treatment, and allow for unprecedented specificity that both improves effectiveness and minimizes side-effects.

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
Sir William Osler, founding professor of Johns Hopkins Hospital

The diagnosis is dead. OK, maybe not dead, but most certainly not as critical as it used to be. It may be a hard pill to swallow, since as human beings, we love to label everything. But we have to move past this mentality, and realize we are all so different and distinctive. Shouldn’t our treatments and plans to restore health reflect this truth? We surely think so.

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4 replies
  1. Henrique
    Henrique says:

    Interesting point of view!
    It would be nice to read some case studies in order to know what the different treatments- and results!- are like in real life.

    Reply
    • Olga Wilson
      Olga Wilson says:

      Thank you for your comment and interest in the article! Innovative Medicine’s specialized approach to healing has been clinically applied at our affiliated medical center, the New York Center for Innovative Medicine, for over a decade with high levels of success. We’re putting together some great stories from patients from around the world that we’re looking forward to sharing very shortly. Any other feedback or suggestions, please feel free to share.

      Reply

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