An interesting editorial thought-piece in the Victoria, B.C. Times Colonist last Sunday (June 1, 2008) wonders about what happens when doctors are unable to diagnose a patient's illness. The gist of the article is that doctors will (my term) loose touch with the patient's reality of life and symptoms and, in turn, the patient is frustrated, fearful and forced to seek expensive resolution elsewhere.
It's a generalization, of course, but personal experience says that it's more likely than not that a doctor will decide what a patient has and treat the patient for that decision but then, if the symptoms aren't resolved, the doctor will be unable to shift or review and may even get into the defensive mantras of "I don't see anything wrong with you" or "you have what I told you that you have and we are treating you for that and your continuing symptoms are irrelevant".
The view of the article's writer(s) is in the frame of the Canadian national health care system but that's not really relevant. At a time when health insurance or HMOs rule how health care is dispensed -- whether you have insurance or not -- the constraints on doctors and patients are pretty much the same wherever you live. If a doctor can't figure out what's wrong with you within the rules established by the insurance provider, then it's going to be a battle to figure out what's really wrong with you and to get it treated.
The article has a focus on a lyme disease instance where the lyme is not showing up in standard tests. So the doctors are telling the patient that she has nothing wrong with her while just looking at her says otherwise. The health provider won't pay for specialist treatment because the tests don't say that she has the disease. Having "been there" with this one, we know how incredibly frustrating this can be. The doctor knows that it quacks like a duck and looks like a duck but their technology only says that it is not positively a duck (as opposed to "it is not a duck") -- so they are frozen with fear and/or regulation.
The article also mentions lupus, of course. We've all been there with that one! How long must the frustration go on? Is there anything that we can do to help the doctors grasp their arts more confidently?


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