Fortunately, most of the issues that patients discuss with us
are routine – at least in terms of making a correct diagnoses. For example, if you come to the doctor with
complaints such as back pain, fever & cough, rectal bleeding, jaundice or
burning with urination – it is likely that a secure diagnosis will be made
expeditiously. Of course, any of these
common symptoms might be caused by a rare illness, but in general, common
symptoms are caused by common conditions. That is why a physician who is evaluating a patient with a fever is not
likely to consider malaria as a leading diagnostic consideration, even though a Google search will include this illness on the fever list.
.
The above symptoms are objective and concrete. Vague symptoms are much more difficult to
unravel because they can often be explained by a variety of medical and
psychological conditions. Do you think a
physician would have an easier time evaluating a patient with a sore elbow than
one who suffers from fatigue and lack of energy? See my point?
Let me create a vignette to illustrate the challenges that medical
professionals often face in determining an elusive diagnoses. I have an animal in mind and I challenge you
to correctly identify it. Of course, if
I showed you a video of the creature in motion, your task would be simple. What if I showed you only a photo of the
creature’s eye or a portion of the tail?
Trickier, of course.
I astutely identify this creature as an elephant.
This is
analogous to the challenge that medical diagnosticians face. With only a few puzzle pieces to work with we
may not be able to recognize what is before us.
We do our best to fill in the scene, but sometimes this is not possible. Additional diagnostic testing may
all be negative. In these instances, we
may opt to guess at a potential diagnosis or treatment, recruit a consultant to
advise us or observe the patient hoping for spontaneous improvement or that the
puzzle will start to fill in as new data emerge.
In medicine, it can be much trickier than the elephant
example I cited above. An illness is not
static and fully formed like an animal.
A medical diagnosis can be fluid with varied and changing symptoms
entering and leaving the scene. It would
be a harder example if the elephant could morph into different creatures.
Readers who suffer with Crohn’s disease, lupus, endometriosis, multiple sclerosis, celiac disease or cancer may have
waited years until the diagnosis was established. This does not mean that the physicians were
obtuse or incompetent. It may be that the
doctors couldn’t recognize the elephant in the room.
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