Wednesday, November 20, 2013

Diagnosis and Treatment

Here is an interesting concept that you have perhaps not heard before....

It is to divide modern medicine in two. It is to divide the medical mind in two and disassociate the usual connection between modern medicine as a diagnostic system and modern medicine as a therapeutic system.

The Diagnostic System
Although I write on the artistic side of medicine, I do not undervalue what scientific medicine has done for health and humanity. I write about the arts because nobody else does and I believe that the two are entirely complimentary to one another. They have a synergistic relationship and are disempowered one without the other.

In fact, I am enamoured and enthralled with medical science and even its technology. I have a thirst for such knowledge and power. I am the one that other doctors come to when they have forgotten something from the medical school sciences or to learn about understand something new in medical science. I am considered exceptional in my applied science, especially my ability to integrate the workings and interactions of the various organs, systems and pahrmaceuticals from first principles. I know and love medical science. I just keep it in perspective.

I am still stunned and amazed at the wonders of scientific medicine and knowledge especially when it comes to modern medicine's diagnostic understanding of the human body and the classification and description of diseases. I am absolutely awestruck at this system based on physiology, biochemistry and pathology.

The modern medical diagnostic system is just peerless and beyond comparison. There is absolutely no competition. It is simply always the best. 

Modern western medicine is the first port of call for any patient suspecting a physical illness unless their symptoms really are trivial and short lived. The only exception I can make there is muscle strain and back pain but physiotherapists, chiropracters and osteopaths work along similar health models and have close contact with the medical profession if they have any doubts.

Every physical health problem needs a medical diagnosis or lack of it. With the latter non-diagnosis, at least the patient knows there is nothing seriously wrong.

And that is where the mental break comes in. It is time to stop. The knee jerk reaction that medical diagnosis leads to medical therapy is not necessary.

The fact that a patient needs medical diagnosis does not mean that they necessarily need medical treatment. Although the western medical diagnostic system has no competition or viable alternative, the same is not true of the therapeutic side of modern western medicine.

The Therapeutic System
I have the greatest respect and perhaps even love for the therapeutic system of modern medicine but I only value it for what it is. Its pharmaceuticals and surgery are by far the most powerful system of intervention available. 

They are not subtle. They are a sledgehammer. They are perfect to bring down a wall but not to crack a nut when that is all that is required. Whether it is pharmaceuticals or surgery, they interfere with a delicately balanced organism. In general, that gives them the worst side effect profile of any available therapy.

Medical education, training and a license is essentially to allow the clinician to make difficult risk/benefit analyses on a case by case basis for therapies that could be dangerous in uneducated, untrained and unlicensed hands. All surgery obviously has its risks but pharmaceutical licensing does not mean that a product is safe. The situation is quite the reverse. The decision to license a pharmaceutical is not primarily based on its effectiveness but on its potentially serious side-effects and contra-indications. Any substance that is believed to have minimal risks to its wanton use by the public is classed as a food or supplement and many foods and supplements have clinically proven health benefits. 

Fundamentally, modern medical therapy is last line therapy not first line therapy. Where life and limb are in proximal danger, it is a no brainer because nothing is as powerful and the risk benefit profile is favourable. However, when they are not, the effect/side effect equation usually favours another option,

Lifestyle measures are the first option. Improved diet and exercise always have a positive, global influence on both objective and subjective health in addition to specific health benefits. They are also empowering and repel the transfer of power and responsibility for an individual's health to the medical profession, reducing the patient driven culture of over-medicalisation and dependency which both have significant health costs.

In the next tier come ancillary medical specialties such as physiotherapy and evidence based psychology. There are also a few evidence based alternative therapies, such as acupuncture for pain control and a few other medical conditions. 

In the last category, which is reserved only for subjective symptomatic relief and minor self-limiting illness, could all be placed under the heading of The Great Healer, Time. Medical intervention carries little benefit in such situations but it can have serious side-effects. The risk benefit equation could be against it compared even to therapies that fail to show more than placebo effect but that have no significant side effects.

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