Betina Thygesen

As I read the newspaper a few weeks back ( NY Times, Tuesday, March 25 2008, When the Disease Eludes a Diagnosis, by Barron H Lerner, M.D.) “Triage” is the latest addition to my ever-increasing English vocabulary. The principle of triage involves dividing patients into 3 categories; 1) patients who will die whether they receive medical treatment or not, 2) patients who will survive whether they receive medical treatment or not and 3) patients who will survive only if they receive timely medical attention. 

Despite it’s morbid nature, this principle is very important if the goal is to save the maximum number of lives possible, which in most civilizations is an obvious purpose of educating people in the medical field. It certainly saved the life of a dear family member of mine who had a massive heart attack just a few months back. 

The fact that our well educated medical doctors have helped millions of people using lifesaving acute operations and long-term assistance through difficult periods with chronic diseases can hardly be disputed. 

What happens though when a diagnosis is elusive - when there is no obvious operation or drug that can make inconvenient symptoms go away? It is easy to imagine how the patient feels – after all we have all either been there or know somebody who has. The patient demands to know what is “wrong” and is in many situations outraged when the doctor fails to state a precise diagnosis and develop a treatment plan for a quick fix. This puts the doctor under a lot of pressure (often to at least mask the symptoms!) 

Fibromyalgia, multiple sclerosis, gastroesophageal reflux, depression, fatigue etc. are all real conditions whose biggest problem is that the existing Western medicine and treatment plans available are not nearly as effective as those available for heart attacks, broken legs and liver transplants! In fact the effectiveness of the drugs and treatment plans for quite a few of these difficult to diagnose “mundane” diseases are repeatedly questionable (side effects however often remain well documented!). 

So what happens when a diagnosis generates more questions than answers? 

Well, if there is a malfunction of the body present, one of those that are difficult to diagnose the last thing you want to do as a patient is to mask the symptoms. This will be a sure way to obstruct the healing that you are looking for. By working with the body/mind connection instead we are much more likely to understand the message the symptoms are delivering. 

As I discuss these issues with a colleague, she very rightly reminds me that we as patients have to accept that doctors are human and that science is not complete! I will add that the personal responsibility in the healing process is 100%. No doctor can heal you. The doctor might fix what is structurally wrong but the healing process is very personal, very time consuming and often not that easy. 

“Once dire illness is ruled out, physicians tend to lose interest”, it says in my article. This, I do not think, makes the physician a heartless creature – merely a human that is doing a very important job saving those mentioned in the third category; patients who will survive only if they receive timely medical attention. 

As we expect physicians and other health professionals to take their responsibility assisting us whenever we are in need seriously, we in return all have an obligation to give our bodies and mind the best possible conditions – that is if we are interested in staying healthy and happy throughout life.