Seeing the Whole Picture

From The Widening Circle by Polly Murray, her thoughts about her first meeting with the Yale doctors:

"As I was drifting off to sleep that night after my meeting at Yale, it occurred to me that perhaps something inherent in the way medicine is practiced restricts physicians’ thinking about new medical problems. Perhaps, being outside of the medical world, I had more freedom to see new possibilities; I had nothing invested in being an expert or in maintaining the image of the all-knowing doctor. For many doctors it may be easier to make up a diagnosis or blame the patient when she does not fit into an established entity. Some physicians may become complacent in the status quo, not wanting to challenge current disease classifications for fear of being wrong or opening a Pandora’s box. Another problem is that many doctors are very specialized, so they may see only part of a given problem, therefore missing connections between different aspects of a complicated disease.

"It is an unusual physician who says that he will listen to all in search of an answer and who acknowledges that perhaps the person living with the disease may be able to provide valuable clues. The doctor who listens and hears is a good doctor."

Murray, P. (1996). The Widening Circle: A Lyme Disease Pioneer Tells her Story. NY: St. Martin’s Press. p. 103.

How the Medical Establishment Thinks

Best-selling author and Harvard Medical School professor Jerome Groopman said in How Doctors Think (2007, p. 5):

"To establish a more organized structure, medical students and residents are being taught to follow preset algorithms and practice guidelines in the form of decision trees. This method is also being touted by certain administrators to senior staff in many hospitals in the United States and Europe. Insurance companies have also found it particularly attractive in deciding whether to approve the use of certain diagnostic tests or treatments….

“Clinical algorithms can be useful for run-of-the mill diagnosis and treatment – distinguishing strep throat from viral pharyngitis, for example. But they quickly fall apart when a doctor needs to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact.”

It is helpful in emerging diseases for doctors and researchers to think methodically, and to build on the solid work of others. But it is also necessary to be ready for the unexpected, both in symptoms and response to treatment, in order to put together the entire picture of pathology and to be of best assistance to the patient.

Groopman, J. (2007). How Doctors Think. New York: Houghton Mifflin Company.

Technology v. the patient

Hillary Johnson, herself an author of a book about an emerging disease (1996) writes in the Foreword to Pamela Weintraub's book, Cure Unknown: Inside the Lyme Epidemic (2008):

"It sometimes seems as if the remarkable technological and scientific advances of the last half century have served to create a medical dead zone in which these contested diseases must languish because the science is still being worked out.... Sir William Osler, a clinician of the early 1900s, revered for his clinical acumen, wrote that studying medicine without patients was like going to sea without charts." (p. xix, xxi)

It is to be hoped that those who seek to qualify the parameters of an illness recognize that patients are not bound by a wish to fit a definition, but a wish to get well.

Johnson, H. (1996). Osler's Web: Inside the Labyrinth of the Chronic Fatigue Syndrome Epidemic. NY: Crown Publishers, Inc.

Weintraub, P. (2008). Cure Unknown: Inside the Lyme Epidemic. NY: St. Martin's Press.