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Making a Diagnosis is Less Important than Asking these 2 Questions
June 07

After 30 years of practicing Medicine, I have learned that for any chronic illness or ailment, treating underlying imbalances and dysfunctions is more important than making a diagnosis and naming the disease. Ultimately, asking the right questions is more important than giving a label to a set of observations.

This is because most if not all chronic problems, from heart disease to arthritis, migraines to irritable bowel syndrome (IBS), depression to fatigue, usually have multiple factors that need to be addressed – this is called the total load. The total load is the sum of the factors that influence a person’s life and health, including diet, exercise, job stress, relationships, state of mind etc. Individually, each of these elements might not cause a problem, but their cumulative effect can overload our normal functioning and cause harm. Everyone’s tipping point is different and each of us manifests or experiences overload in our own unique way.

For example, several patients may all be diagnosed with IBS but the individual factors underlying their illnesses may be varied, meaning that each requires different treatments to address their specific problems. Simply diagnosing these patients with IBS, obscures this critical fact.

When working with patients, I always assess their total load and then try to reduce it by slowly removing the factors that could cause harm. At the same time, I will add new elements that will nourish them in order to enhance the healing process.

Some examples of what may need to be reduced or removed from your diet are, sugar, chemicals, caffeine, or alcohol. Or you may need to lessen the burden of responsibilities, your work load, or how much tension you carry in your muscles. Examples of factors that may be lacking and need to be added are nutrients, sunlight, sleep, down time, play time, love or joy.

To understand the concept of total load, think of yourself as a ship floating in the water. Depending on the load you’re carrying, you are either riding high above the waterline or sinking beneath the waves. And just as you can save a sinking ship by tossing some ballast overboard to lighten the load, your health can be improved by reducing the overall number of factors that cause stress to your system. The good news is that frequently you may only need to identify two or three factors to toss overboard in order to feel better.
Unfortunately, I, like all doctors was never taught this at medical school. Instead, we were taught to name it, blame it and tame it. That is to look at the symptoms, signs and test results, make a diagnosis, name the disease and treat it.

This model works well for the acute or short-lived illnesses that were most common until about 70 or 80 years ago. There is no better model for crisis care management, such as a heart attack or burst appendix, a broken bone or an acute bacterial infection like pneumonia. Due to the incredible success of antibiotics in treating most infectious diseases, we have extrapolated that model, looking for a single cause with a magic bullet treatment, and adapted this thinking to all diseases.

But most complaints today are not acute illnesses, rather chronic problems, which are not served well by this model in which varied complex disease processes are reduced to a single diagnosis. Giving a set of observations a name and treating the named problem does not help us understand the origin of the problem and its causes, which are usually multi-factorial. This name-it, blame-it and tame-it medical paradigm is not particularly effective for the chronic diseases which are so endemic today.

I want to make it clear, a label or descriptive name for a problem is not a bad thing–it is often reassuring to know what we have. I do not want to under-estimate the significance of this. But we have been habituated to assume that if we know the diagnosis and the name of our disease we will know how to not only treat it, but fix it.

Unfortunately, this is not true. Doctors are increasingly practicing from the vantage point of an outdated and ineffective model and are not addressing the needs of the millions of patients who come to them with complicated chronic problems. They give them drugs to suppress symptoms and do not address the underlying physiological imbalances that produce these symptoms. Therefore we do not change the course of the disease and often end up causing more harm than good because the underlying problem persists and many people develop side effects from the drugs.

Luckily for all of us, there is a new little known science-based model for chronic diseases, called Functional Medicine that deals with the underlying causes instead of just suppressing symptoms. It is a true mix of Chinese and Western Medicine. This new medicine is systems-based biology rather than disease-focused. It redefines chronic disease as a functional alteration in the physiological network that requires a systems biology approach to its management, improving both the safety and effectiveness of treatments.

This model helps us understand how the disruptions of molecular pathways cause dysfunctions in various body systems that then result in disease. It is less concerned with a diagnosis and more concerned with the underlying dysfunctions that lead to the symptoms and the disease.

My Chinese Medicine teachers taught me to think of myself as a gardener when I see patients. When a plant or tree is not growing well, when the leaves are drooping and turning yellow, we do not call it yellow leaf syndrome and paint the leaves green or cut off the sick part. The gardener evaluates why the plant is not growing well. He determines whether the plant is getting enough or too much sunlight, enough or too much water, is the soil rich and balanced in order to nourish the plant? And he looks to see if the roots are being impinged upon, and if so, what needs to be removed.

Even though you may have been given a diagnosis, always ask these two questions with any chronic problem

    1. What is harming you and needs to be removed to permit the body to heal?

and

  1. What is lacking or what does your body need to promote healing?

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  • Buckeyern_babs

    Wow!  Very powerful!  Consistent with my holistic nursing practice base.  Now, I need to take these questions into account for myself as well.  Lessons well learned.

  • Johny_kristy

    So so true!!!

  • http://www.facebook.com/profile.php?id=1178079615 Terry Roof

    We think the diagnosis is the answer only to become disappointed or frightened when it comes. Now, to find a healthcare provider who can answer these two, often lifesaving, questions…  Thanks for posting.

  • Judith C. Stern

    Hello Frank , This sounds to me like the principles of the Alexander Technique, discovering the habits that interfere with optimum function, learning how to identify and change those habits while adding new more effective behaviors. What is harming us can look so many different ways. Excess tension is certainly one well identified interference and does not support health and well-being.
    I read your weekly reports with great interest and find them remarkably informative.
    Thanks
    Judy Stern,MA,PT
    Certified Teacher of the Alexander technique

  • http://pulse.yahoo.com/_VR4NSXX6GSP47QZ6GZLLSZTUBQ Dave Sparks

    Hi,
    This is a very different and interesting post and this is what is called out of box thinking. You have some very good writing skills and I admire them as well.
    Keep it up.
    :)
    __________
    symptom diagnosis

  • http://www.facebook.com/thadchawan.sirithamwanich Thadchawan Sirithamwanich

    Most of your ideas match with what my father had taught me. My family is Chinese doctor in Thailand. I just want to say that you’re on the right track. Too bad there’s no such chemical medicine to serve your purpose. There’s certain level of damage from disease human body can take and it can still heal itself. Beyond that point you need medicine that can help the cells to regain their strength. Herbs are the answers but you have to use them as they are. Crude not chemical compound.

  • Stephen

    “Doctors are increasingly practicing from the vantage point of an outdated and ineffective model and are not addressing the needs of the millions of patients who come to them with complicated chronic problems. They give them drugs to suppress symptoms and do not address the underlying physiological imbalances that produce these symptoms”

    Yay! I’m glad he made that point! I don’t need to remove or suppress the symptoms. I need the underlying problem FIXED! Thanks, Dr. Lipman!