Your Diagnosis and You

Having a diagnosis is like knowing your batting average.  The batting average isn’t the player, it is merely a description of the outcomes from a player’s previous at-bats.  It isn’t predictive of what will happen at any particular at-bat and definitely doesn’t predict what will happen on any given pitch.  Pitchers don’t waste their time developing strategies for dealing with a .300 hitter; they keep records about how to pitch to Derek Jeter.  A batting average’s only real value is in comparing players to each other and keeping records.

Can you imagine a pitcher who doesn’t care who the guy at bat is, as long as he knows his batting average?  Imagine that pitcher then thumbing through a book to remind himself what the protocol for pitching to someone with a .240 batting average is.  “Ok, it says to start him with a fastball up and in, then a curveball that breaks outside and low, and finish with another fastball up and in.”   Now how stupid is he going to feel when he finds out this batter’s favorite pitch is a fastball up and in?!

Likewise, your diagnosis is not you.  It is merely a description of some aspect of your state of health.  It doesn’t predict how you will respond to life or a given treatment plan or to any particular treatment option whether you’re talking about a drug, herb, surgery or homeopathic remedy.  And, this is the big one that has gotten f’d up in mainstream medicine… doctors shouldn’t waste their time developing treatment plans to deal with a diagnosis, they should be focusing on treating the person in their office.  A diagnosis code’s only real value is in comparing groups of people and discussing them with other health professionals without giving away anything that would compromise confidentiality.

Can you imagine a doctor who doesn’t care who the patient is, as long as he knows the diagnosis?  Imagine that doctor then thumbing through a book to remind himself what the protocol for treating Diabetes, Type II is.  “Ok, it says to start with glucophage, an ACE inhibitor, and give him the handout that says he should start exercising and eating according to the ADA’s diet guidelines.”   How effective is this going to be when the patient already eats according to the ADA’s guidelines, takes 400mg of ibuprofen three times a day (which interferes with ACE inhibitors) because of chronic back pain, and already exercises 3 days a week?!

Treating the cause involves addressing the reason the person is struggling with something that can be labeled with a diagnosis code.  A person doesn’t have diabetes because they got the diagnosis “Diabetes”!  Putting them on a protocol for Diabetes is not the same thing as addressing the cause of it or the person with it.  This strategy merely manages the disease… the apparent end goal of Health Management Organizations (HMO’s).  If you want to treat the cause you have to dig deeper than the diagnosis itself.  The diagnosis is the chapter heading, not the book.  It is the average, not the batter.  It is the description, not the patient nor the cause.

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