Why Doctors and Patients Have Different Priorities

Friday May 16, 2014 | BY |
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Doctor Patient

Just as lab test numbers are not human patients, codes are not diseases.”

Traditional doctors love algorithms.

Patients X, Y, and Z have A, B, and C diseases. Patient X has disease B, which has an ICD9 (soon to become ICD10) diagnostic code. ICD codes (International Statistical Classifications of Diseases) are alphanumeric codes given to every diagnosis, description of symptoms and cause of death attributed to human beings.

Just as lab test numbers are not the human patients, however, codes are not diseases. They are simply part of a system that makes it easier for doctors, hospitals, and health insurance companies to keep track of what’s going on with patients.

A medical algorithm is a formula used in healthcare to manage a specific diagnosis. Your doctor uses this kind of flow chart as a “look-up table” for the management of common health conditions like high blood pressure and diabetes.

What an algorithm can’t tell us is:

  1. how to understand the disease from different perspectives,
  2. how to tease apart the elements that had led up to the current situation, and
  3. how to come up with a workable plan. For example how to prevent an otherwise healthy man from ending up blind, impotent, on dialysis and in a wheelchair from foot amputations due to not controlling his blood sugar.
Still Smoking After a Life-Threatening Scare

Not long ago, a middle-aged male patient had a terrible pain in his lower leg. In his mind, it seemed to come out of nowhere. He limped and cringed, thinking it would go away, but then his leg got swollen hot and red. At the time, he was visiting a former college friend who was a doctor. When his friend saw his leg, he sent him right to the hospital for tests, and found blockages in his arteries. The patient was sent to a vascular surgeon who performed an emergency operation that likely saved his life.

When he finished recounting the story, I asked if he was still smoking two packs of cigarettes a day. He hadn’t cut down at all despite being informed by the surgeon that it was excessive tobacco smoking that caused his problem. Along with inactivity and years of long sitting—and a genetic sensitivity to conditions of the arteries—he was prone to peripheral obliterative arteriopathy (ICD-9 443.9), the obstruction of large arteries from inflammatory processes possibly leading to sudden death.

“That’s what they told me at the hospital,” he confessed.

He wanted to know if I could fix his condition with diet and vitamins, and maybe some detox therapies like juice fasting. I said that they would help a lot, but he had to stop smoking.

The surgeon knew his algorithms. But the patient had his own agenda, which required continued smoking to gain the benefits of his nicotine fix. He was looking for ways around the problem.

The Gap Between Doctor Recommendations and Patient Understanding

Doctors and patients often have different priorities. In this case, the patient’s medical doctors were right, but the patient wasn’t able to make the connection between the circulation in his legs and smoking.

What the algorithm couldn’t tell him was why he started smoking to begin with, and why he could stop now. His doctors couldn’t explain to his satisfaction the connection between a lifetime of smoking, lack of exercise, and too much sitting and his severe leg pain.

I couldn’t provide him with a simple reason why smoking starts an insidious process of whole body inflammation that eventually landed in his leg. And he couldn’t muster the willpower to quit smoking simply because it was bad for his health.

We Have to Look at Health Problems in Different Ways

It gets even more complicated with chronic complex modern diseases like fibromyalgia or autoimmune conditions like Hashimoto’s disease. In these cases, algorithms as simple devices that make it easier for doctors to prescribe drugs don’t work at all for patients, because the drugs don’t work and cause side effects.

Fibromyalgia was not even considered a disease twenty years ago, and even now most traditional doctors refuse to believe that patients have all the symptoms associated with fibromyalgia.

An algorithm won’t tell your doctor how to heal your gut, or why gluten sensitivity can be a soft trigger that starts a cascade of biological events that eventually lead to the soft tissue pain, fatigue, and brain fog associated with fibromyalgia.

What I tell my patients who are confused by a medical system obsessed with simple and elegant solutions that don’t work: We have to look at complex health problems in different ways.

When I step back and look at their condition in its biological entirety, it’s not just holistic. By seeing multiple views that overlap and interrelate, I get a sense of what’s going on with the individual person, their biology, and the processes that lead to the symptoms that make up their disease. I call this “big picture” medicine.

But the big picture isn’t enough to get my patient well. It requires multiple small steps, each targeting varying aspects of health and disease. These baby steps toward health are what you do every day to get better. I refer to this way of keeping tract of symptoms and progress as the small picture. And, it takes time.

The body needs time for recovery and rest to restore all systems and reorganize its biological systems in order to return to health.

That’s where natural medicine comes in. Getting function back to normal requires fasting, avoiding allergenic foods like gluten, nutrients, anti-inflammatory herbal compounds, and countless other factors. It’s a journey, not just an algorithm.

Dr. J. E. Williams

J. E. WILLIAMS, OMD, FAAIM

Dr. Williams is a pioneer in integrative and functional medicine, the author of six books, and a practicing clinician with over 100,000 patient visits. His areas of interest include longevity and viral immunity. Formerly from San Diego, he now resides in Sarasota, Florida and practices at the Florida Integrative Medical Center. He teaches at NOVA Southeastern University and Emperor’s College of Oriental Medicine.

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3 COMMENTS ON THIS POST

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  1. Sofia says:

    Great article! This makes so much sense, I just wish more people this way.

  2. June Hansonl says:

    Windows was configuring something or another, and lost my comments to you. Hope You got them. Anyhow, I am enjoying the journey. Been some rough spots, so glad to get some of them ironed out. Glad my blood tests, and also me, are not just a number to you. We are both learning how to deal with stress. Worked, so hard at it, that things, can only get better. Physically, mentally and emotionally, I am learning to deal with it. So, very thankful, for the help you have given me. The patience, well, most of the time (smile), that you have had with me! Anticipating, a great future. Might have to go through, some rough spots here, to get there, but it will be worth it. Anything worth while having, is worth the struggle, to get it. Am getting, lots of rest, exercise, eating my veggies, protein,….now fasting, is what I need, gonna, leave that up to you.

  3. Satori says:

    Great article. Not everyone wants a quick fix to cover-up the symptoms temporary. I want complete healing for most of things.

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