The Tyranny of Diagnosis

For a profession that primarily concentrates on the well being of the human being, we seem to be very disconnected with the suffering person. We hide behind the facades of cases/bed no./patient ID or sometimes, even diagnoses/differential diagnoses to depersonalize the man who is suffering the disease. We end up diagnosing the disease, treating the disease, whereas we were supposed to diagnose the patient, treat the patient. In the whole brouhaha over the disease, the person suffering from it is pushed into the background. This preoccupation with the disease rather than the diseased was not well appreciated by me till I got my heels wet, actually practicing medicine. And realization hit home, and hard, after a couple of personal experiences. One was when my uncle needed a Trans Urethral Resection of Bladder Tumor, and the next, when a friend’s dad had an AMI. On both these occasions, I was on the other side of the glass windows, and I realized that, whether we realize it or not, doctors have an inherent preoccupation with the disease and not the one suffering from it.

Whether you call it an effect of a defense mechanism to ward off the unpleasantness that comes of a close relationship with a patient who eventually deteriorates or whether you call it the law of the jungle, it matters not. Because eventually, we end up alienating the person behind the diagnosis. If you ever work a shift in the ER at my hospital, especially in the frenzied hours, you will realize how little we end up paying attention to the problems of the patient actually. We treat the symptoms, we treat the pathology, we treat the pain. And then we move on to the next set of complaints. We do an excellent job of managing a grossly understaffed ER, but I am sorry to say, we rarely treat the patient.

And that, somehow, has rubbed off on our education system as well. We study about diseases as if they were a long list of things to be memorized and correlated. But is that the best possible way? In the rush to learn about the disease, we end up ignoring the patient. I am sure you will agree with me when I say that there are different stories to the same disease, different histories, different quality of life concerns – all because the patient is different. This simple, linear approach towards medicine is an over simplification. In my opinion, it is a veil that hides an unexplored terrain. Do we worry over leaving the known, tried, tested and trusted path, and venture into the unknown? Yes, of course! There is no incentive for us in taking the risk. Come on, we all know mugging the last 25 years’ MCQs back to front will get us through any kind of entrance exams. Learning a laundry list of symptoms of MS is the way to go, and not reading about it like this:

Diary of MS – symptoms to diagnosis
by Gael Finch

I’m feeling quite tingly all over today,
It’s really quite nice in a strange sort of way,
But then numbness creeps in, the tingliness goes
And all of a sudden I can’t feel my toes.

By mid-afternoon it has spread to my knees,
Best go to the Doctor, “An appointment, please”,
“Let’s just wait and see as I haven’t a clue,
It’ll probably get better, or it may be just flu.”

Two days later and still feeling numb,
Back to the Doctor, (as advised by my mum);
“Altered sensations, that’s what you’ve got,
It’ll sort itself out”; Has he lost the plot?

The next week, I’m back and at last my GP
Says see a Neurologist (whatever that may be);
There’s a 3 month wait?  Oh well what’s money for?
The very next week I’m knocking at his door.

He prods me and pokes me with hammers & pins
He tests me for weakness and guess what, he wins;
You’ll need a Lumbar puncture and an MRI scan
At last someone believes me, he’s a very nice man!

The scan comes back normal, so I must be OK,
But first there’s the spinal, oh please go away.
Inflammation shows up in my spinal cord,
“It may come back”, I’m told, “of it’s own accord”.

“Now if it comes back, and it probably will,
Then you’ll have MS, but not until.
So you’ve probably got it, but then maybe not,
Don’t think about it”, well at least not a lot.

A few months have gone by and the tingle’s come back,
This time in my arms and a little round the back.
The bathroom it seems is my favourite place,
And suffice to say I’m not washing my face!

So back to the Neurologist, that very nice man,
Who says, “Well; this is it” (as nice as he can).
So here I am with “official” MS;
How will it progress? well that’s anyone’s guess

Live day to day, you can’t alter fate,
If you’re tired, go to sleep, the washing can wait,
One thing I know, and I hope you can see;
I’ve got MS, but it’s not having me!

© Gael Finch, 2001

I know the system is cruel and I hate to be bound by the limitations it imposes on me. Don’t you?

I was wondering if we could rewrite this. Instead of this linear approach that defines our medical practice and education, how about taking a roundabout view of the same scene – through a narrative based, evidence bolstered, systematic approach? Do you think we could rewrite the chapters of our medical school curriculum with this alternative approach? I am wondering of there is any place for narrative styled, user driven pedagogical tools. Clinics, pre-clinics, para-clinics, evaluation system (aka EXAMINATIONS), whatever be your interest, do you want to look in through this looking glass and see what the medical/healthcare world looks like from the other side?

P.S.: This is a repost from an old blog. It is inspired by a recent conversation I had… So there was this guy who believed in all the crazy-ass stunts I pulled in medical school. While he may not have been pissed enough to get up off his lazy bum to raise as much hell as I did, he, nevertheless, was pretty supportive of me. Until we talked yesterday, that is… that is when he told me that it is pointless to fight. The system always wins. A lone crusader is just another failure…