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What’s In A Name?

As I’ve educated myself about different ways to practice medicine, certain thing become more clear. The foremost problem I find in conventional medicine is it’s reliance on being disease/diagnosis-centric. The sole focus of our medical industrial complex, which includes academic institutions and medical teaching, our insurance-based healthcare delivery system, and expert opinion/national guidelines, is to place labels on patients. This labeling is of course how, I and nearly every western physician has been trained since the time of ancient Greece and Rome. Those early physicians were some of the first to combine history taking and physical exam and then place labels on patients, known as a diagnosis.

As with most aspects of conventional medicine, diagnosis labeling works best when dealing with acute, dangerous conditions. For example, when someone presents with chest pain, using a patient’s history and physical exam along with diagnostic testing can quickly differentiate between possibilities and lead to diagnosis. Having this diagnosis label is crucial because treatment is urgent and will vary with different potentially life threatening conditions such as heart attack, blood clot, or pneumonia, or even confirm the case is not dangerous, limiting need for aggressive therapies.

Acute conditions are where western, traditional medicine shines and for the majority of modern history (last 2000 years), medicine primarily dealt with acute conditions as there was fairly little chronic disease. However, the past 75 years have seen a shift to chronic disease being the predominant force in American health care. According to the CDC, 70% of all deaths and 86% of all healthcare dollars spent in the US are due to chronic disease. Due to the overwhelming prevalence and importance of chronic disease, we must recognize the failure of our traditional system to address these issues.

The approach of conventional medicine for chronic disease is sadly the exact same as for acute conditions. Whereas in acute illness, there is commonly a clear and precise cause for one’s symptoms, in chronic disease there is never a finite, universal cause. While two patients can have identical symptoms and exam findings leading to the same label (e.g. heart disease, irritable bowel syndrome, arthritis), their causes can be completely different. It would make sense then that their treatment plans would also be different. However, in convention medicine, once the diagnosis label is placed, treatment options become limited and more often than not are just one or more of a handful of pharmaceutical agents that go with that label. In fact, not only is personalized diagnosis and treatment not regularly taught or performed for chronic conditions, it’s actually directly rejected as bad medicine by academic institutions and insurance companies. Guidelines routinely come out saying for any patient with a given label, “this” is the correct treatment approach and all patients should receive “this.”

As my experience grew, this dysfunctional way of thinking about chronic disease has led me to diverge from traditional models, and frankly practice differently than most other medical doctors, quite commonly in direct opposition to what would be considered the standard of care.

Thankfully, there are many other physicians who reached the same conclusions as I about the failure of our system to address chronic disease. I’m proud to be part of a group that understands, creating health and reversing chronic disease involves truly understanding all aspects of a person, and individualizing a plan for each of them.

4 Pillars Functional Medicine – What's In A Name?

 

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David Gordon

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