How entertainment has altered our desire for diagnosis

I remember, some years ago, sitting with a relative across a large wooden desk in a doctor’s private office. We discussed symptoms for half an hour during an initial consultation. On a different occasion, I recall another doctor pinning an MRI on the wall, circling an area and articulating exactly why the radiologist overlooked a diagnosis. There once was a doctor who stood bedside, outlining what was known, what was baffling and how it would be investigated. Back in those days, there were even phone calls from physicians with results. Does this sound like an episode of Royal Pains?

Entertaining good physicians

Perhaps entertainment has altered our perception of medical reality. Some of the most popular television shows have invited viewers behind the scenes of hospitals — notably, House MD and E.R.In different ways, television may have elevated our perception of doctors’ ability to quickly diagnose and treat diseases. By demystifying the most perplexing ailments within the span of an hour, all “good physicians” are equated with capable diagnosticians.

Rightly or not, as a patient, when I visit the doctor, I am lulled into the notion that I deserve, even must have, one of these good physicians. In the absence of an astute diagnosis prior to treatment, my physician must be the contrary. This makes me long for the foregone days when doctors cared about patients, when they treated the whole person, not just the symptoms. But wait. Do I actually recall such a historical time or are these vignettes just figments of my entertainment-filled imagination?

What’s missing from abundance of care?

Over the past couple of decades a different pattern has emerged. With rising health costs and more patients in the waiting room, many physicians have been constrained to delegation, referral and pre-diagnostic prescription for non-life-threatening conditions. Visits to primary care physicians feel more like a triage. Patients are moved through exam rooms with efficiency and dispatch. Even if doctors wish to spend more time with a patient, the overcrowded waiting room dictates otherwise.

I can’t quite accuse doctors of carelessness. Brain tumors are ruled out with an MRI in response to headaches. If a patient presents numbness, a team of cardiologists, neurologists and physical therapists receive referrals with plenty of blood draws and lab tests. All this activity provides a chimera of care. Insurance companies and patients with high deductibles see plenty of billable services. So what’s missing? A diagnosis.

Idiopathic diagnosis is an oxymoron

Prescription in lieu of accurate diagnosis is becoming commonplace. There are certain prescriptionable buzzwords requiring little patient explanation. Skin eruption? Eczema. Aches and pains? Non-specific inflammation (or myalgia). To be fair, many patients present ailments for which proper diet and exercise is the remedy. Since doctors can only advise but not administer these, treating symptoms keeps complaints down.

When an unexpected pain arises under the current healthcare model, I anticipate, following an 8-minute consult, lab work to rule out major things like an excisable mass or cracked skull. If results are negative, I am prescribed a pain reliever and shouldn’t concern myself with the whys and wherefores. The “diagnosis” is bound to be “idiopathic” or worse yet, one that will later be rescinded.

There appears to be a real shortage of diagnosticians. Overloaded internists are attempting to pick up the slack but the declining level of care is apparent. What about you? Are you more concerned with why a particular illness developed or just how to relieve it?

Kevin R.R. Williams blogs at ClinicalPosters.com.

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  • Cass

    It depends… how long has it been going on for, and is it getting worse? (this is from a patient’s point of view).

    Getting a diagnosis of “migraines” and being told to take some Tylenol, avoid coffee, and get a lot of sleep is fine if the patient has had them for a couple of days.

    Getting a diagnosis of “migraines” and being told to take some Tylenol, avoid coffee, and get a lot of sleep is insulting if they’ve kept the patient in bed for two weeks, and just keep coming back.

    So one time thing that causes no damage when it’s over: relieve it.

    Recurring thing that keeps happening and affects your daily life: figure it out. Fast.

    • http://ClinicalPosters.com/ ClinicalPosters

      Valid point. In my experience, extended duration nor sudden increase in frequency seem to phase HMO physicians I’ve encountered. There are better solutions to this standard of care.

      • wiseword

        The word is “faze,” not “phase.”

        • http://ClinicalPosters.com/ ClinicalPosters

          Thank you. Do you have any other comments on the article as a whole?

  • Suzi Q 38

    I agree with your article.
    I had a hysterectomy almost two years ago. Shortly after, I started experiencing weakness in my thighs (saddle areas).
    My gyn/oncologist swore up and down that it wasn’t his surgery.
    I told him that O.K., if it wasn’t the surgery, what is it???
    We patiently waited for the weakness to go away after 6 months.
    It stayed, and escalated when I exercised.
    I was finally referred to a neurologist. He did a Lumbar MRI, and ordered PT.
    I improved a little, but the weakness was still there.
    fast forward to a little over 1 year post hysterectomy April or May of 2012: My condition escalated further and I started developing myelopathies (numbness) in both hands and feet.
    The neuro ordered Neurontin. I took it a few days, then realized something.
    “Why am I just taking a drug without finding out what is wrong?”
    I told the doctors that I refused the Nerontin for the reason above and the fact that it caused weight gain.
    They wrote down on my chart: “Patient refuses the Neurontin because it causes weight gain.” What a crock. They never even mentioned the real reason I refused to take the drug.
    I said to them: “Why should I take it? You still don’t know what is happening. All it does is mask important symptoms that need to be addressed.”
    To make a long story short, my gastro saved the day. He said: “Ask your doctors to take a look at your upper spine.”

    I told my neuro what the other doctor had said and he finally ordered a full MRI in all 3 places (C, T, and L). Bingo.
    Unfortunately it showed multiple problems with my back, and especially neck area of my spine. Diagnosis: Spinal Stenosis.

    Gee. We still don’t know what caused this. We don’t know if I had it before, or I was dropped on my head during or after my surgery.
    We are in the process of ruling out M.S. to be fair.

    All I know is, I walked into the surgery without these symptoms.

    It took this long because of delay of care.

    In April or may, I was so concerned about my escalating symptoms and difficulty walking that I wrote my gyn a 5 page letter, outlining my concerns and asking for advice and help.
    He was so annoyed that he refused to answer and ignored me and my letter.
    I was so sad and shocked that I decided to go ahead with an impending 30TH wedding anniversary tour of Europe that was planned months in advance.
    On the trip I walked a lot and it made everything worse.
    I came home having to use a wheelchair to get from the parking lot of the teaching hospital to my neurologists office.

    All of this landed me in the neurosurgeon’s office, who was a very good man that was very angry at the doctor that had not only ignored my symptoms but my pleas for help.

    He called the doctor and told him how wrong it was of him to do this.
    To make a long story short, I almost reported the guy to the California Medical Board.

    I am still thinking about it.
    First I have to think about myself and get the right surgeon to do this surgery after they rule out M.S.

    My point: Surgeons want to cut. When stuff goes wrong the run for the hills instead of trying to see what the problem truly is.

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