by Dr. Leo Galland
Do you feel like your thoughts about your condition have been brushed off or dismissed at the doctor’s office, because they’re not relevant to the diagnosis?
You are not alone.
The type of thinking that says anything outside of the box is irrelevant to the diagnosis means that critically important information is often missed.
Why does this happen?
Because conventional medicine looks at you as a diagnosis.
As a disease.
From treatment to insurance, it all comes down to a precise diagnostic number. In the U.S. today, whatever ails you has to be assigned a number called an ICD code.
Then the tests and treatments you receive are assigned another set of numbers called CPT codes. And the CPT code better match up with the ICD or your insurance will not cover the costs.
With the importance of the numbers in the process, you could easily feel stripped of your individuality.
It’s as if by focusing exclusively on one single aspect of you, the disease, a positive outcome to treatment will prevail.
Except for one thing: the human body doesn’t go along with that simplistic formula.
And neither should you.
We all know there are times when the newest therapies and drugs are effective, and we want to benefit from that.
But there are many, many times when the newest treatments and drugs just don’t work. Or they make things worse.
Conventional medicine usually throws up its hands at this point. After all, it did what is was supposed to do, by the book, to treat the disease.
But it ignored the patient, the complex individual with his or her own unique characteristics.
As a practicing physician, I have seen the limits of this approach, because patients’ problems are never fully explained by their diseases. There is almost always something quirky or strange that separates each person’s illness from the textbook case.
Sometimes there is little correlation between the patient’s pain and distress and the pathology that could be measured. (1) Often, the response to treatment is unpredictable, each patient responding as a unique individual.
So why does conventional medicine continue to focus primarily on the disease?
It’s because medical schools traditionally teach healthcare professionals to look at diseases, rather than focusing on the person.
Practically, it works like this: a patient presents one or more problems to a physician, who uses the nature of the problems, the medical history and the physical exam to generate a differential diagnosis.
The system kicks into gear to answer the question, "What disease does this patient have?" Laboratory tests, MRI or other imaging tests, and invasive procedures, when needed, help confirm the answer.
The diagnosis guides the treatment: a positive response to treatment works to further confirm the diagnosis.
This highlights the essential blind spot of conventional medicine; it ignores the uniqueness of the person who is sick. It assumes that all people with the same diagnosis have the identical disease.
But illness is not the same as disease diagnosis. Diseases don’t just happen, but are the result of complex, interacting factors that act upon the individual.
And each person responds to treatment in his or her own unique way.
Frustrated by the limitations of conventional medicine, I have explored strategies that go beyond the conventional, studying nutrition, psychology and exercise. I have been amazed to discover that although so much of medical relevance within these disciplines has been published in medical journals, little has been included in the practice of medicine.
So I developed a unique diagnostic approach that is organized around the person, rather than the disease. It is called person–centered diagnosis and it’s described in detail in my book, Power Healing, Use the New Integrated Medicine to Cure Yourself.
Person–centered diagnosis looks at the identity of the patient, in all relevant dimensions–genetic, environmental, psychosocial, structural, and nutritional, to make the diagnostic process more comprehensive and effective and to help doctors and patients understand their illnesses more clearly.
People have an intense need for explanations about the causes of their diseases. Doctors are often content to name the disease and treat it. Patients want to know how they came to be sick, so that they can attach some meaning to the illness. They want to know what to expect from the illness and what they can do to relieve symptoms or speed recovery.
Information can reduce anxiety, increase feelings of personal control, and improve the ability to cope with pain. A study from the Institute for the Improvement of Medical Care and Health at the New England Medical Center found that patients who were encouraged to ask more questions and participate in decisions about their care fared better in the outcome of chronic conditions such as high blood pressure, diabetes and ulcers. (2)
With all the advances in medicine, it’s important to remember one simple thing that could make all the difference: the quality of the conversation between the doctor and patient. The authors of the New England Medical study concluded "the physician-patient relationship may be an important influence on patients’ health outcomes and must be taken into account in light of current changes in the health care delivery system that may place this relationship at risk."(3)
As a patient, you must be allowed to present your major concerns and to tell your own story.
Patients who are given the opportunity to present their concerns in their own words are:
• more satisfied with their physicians,
• cooperate more fully with medical treatment,
• show a greater improvement in health status,
• lose less time from work and
• experience fewer limitations of function.
To facilitate communication, I have compiled five steps that can help in talking with your doctor.
Five Steps to Being a Proactive Patient
1) Describe the effect that illness has had on your life, your daily activities, the way you perform your work, your recreation, your relationships with those close to you. If your doctor doesn’t ask, tell him or her.
2) Express your feelings about the illness. Your fears, your frustrations, your anger.
3) Present your goals. What a person wants from a medical consultation is usually not obvious from the list of his medical complaints. A study from Temple University School of Medicine of patients in a primary care practice found that seventy per cent were hoping for education about their diseases, forty-three per cent wanted advice about diet and exercise, and twenty-four per cent wanted stress management counseling.
(4) If your doctor doesn’t ask what you want, tell him.
4) Do not wait until the end of your appointment to express your major concerns. People consulting primary care physicians often introduce new problems, not previously mentioned, during the last minute of the office visit, as the doctor is getting ready to leave the room. (5)
5) Actively participate in developing a therapeutic plan. You are the person who has to implement it, after all, even if it only requires taking pills. The best physicians encourage their patients to take an active stance in their care, so that patients assume a collaborative role. This improves satisfaction, cooperation and level of activity for patients with a wide range of chronic diseases. (6)
1) American Sociology Review 1966, Vol. 31: 615-30, "Culture and symptoms: an analysis of patient’s presenting complaints." Zola, I.K.
J Am Med Assoc. 1956 Aug 25; 161(17): 1609-13. "Relationship of significance of wound to pain experienced." Beecher, H.K.
2) Med Care. 1989 Mar; 27(3 Suppl): S110-27. "Assessing the effects of physician-patient interactions on the outcomes of chronic disease." Kaplan SH, Greenfield S, Ware JE Jr.
4) Med Care. 1989 Nov; 27(11): 1027-35. "The relationship between patients’ satisfaction with their physicians and perceptions about interventions they desired and received." Brody DS, Miller SM, Lerman CE, Smith DG, Lazaro CG, Blum MJ.
5) J Gen Intern Med. 1994 Jan; 9(1): 24-8. "Oh, by the way … the closing moments of the medical visit.” White J, Levinson W, Roter D.
6) Ann Intern Med. 1985 Apr; 102(4): 520-8. "Expanding patient involvement in care. Effects on patient outcomes." Greenfield S, Kaplan S, Ware JE Jr.