The biomedical approach to health and illness, not only puts lesions, or pathological changes in the body’s tissues or symptoms, at the heart of diagnosis and treatment. The idea is that disease is a physical phenomenon, with changes which can observed and/or measured. However, what drives patients to consult doctors is frequently not the sudden appearance of a lesion which can be seen. Rather, it’s often the experience of a symptom. Some of the commonest symptoms include pain, weakness and dizziness.
Researchers who have studied patients with common symptoms have found that in a large proportion of cases, there are no objective findings which might explain the presence of the symptoms. This may be dismissed as “in yer heid”, or “nothing wrong” but both of these judgements are unfair and inaccurate. The occurrence of symptoms in the absence of detectable tissue changes has been labelled “Medically Unexplained Symptoms” (MUS) This is a very, very common situation. Different studies have shown that a lack of a medical explanation may occur in 30% of all consultations at a Primary Care level, and in up to 85% of those with particular, common symptoms.
This is really a big problem.
- Firstly, all treatments, surgical or pharmacological, are directed against lesions – measurable, pathological changes in tissues or systems. So, in the absence of such pathology, modern medicine’s tools are hopelessly inadequate.
- Secondly, non-surgical and non-pharmacological treatments are not well developed, tested or proven, so patients in this situation often end up with operations or drugs because no other solutions are known, and these interventions all carry risks of harm, so patients find that not only are they not helped, but they end up worse off because of side-effects and other iatrogenic harms.
- Thirdly, patients in such a predicament often find their suffering dismissed as either psychological and sent for psychiatric treatment, or, worse, find that they nobody actually believes that they are experiencing the suffering they are complaining of.
- Fourthly, (and this one is hardly ever mentioned), the existence of “MUS” suggests that symptoms are not the reliable indicators of disease which doctors assume them to be. This leads to the problem of patients whose symptoms are ascribed wrongly to the discovery of pathology. Just because some inflammation is found, or a growth is found, it does not mean that this pathology is the whole cause of the symptoms which the patient is experiencing. In fact, it does not even mean that the pathology is the partial cause of the symptoms. This can lead to the prescription of drugs or the carrying out of surgical procedures which make absolutely no impact on the patient’s suffering.
The concept of “Complex Adaptive Systems” gives us another whole way of understanding such diverse and difficult symptoms – the problem need not lie in a body tissue or in the mind – the problem can lie in maladaptation or malfunctioning of the system as a whole. Such a concept leads to a demand for holistic interventions, because no simple, single-explanation, solutions can work.
Heroes Not Zombies 
After reading your post, I want to say something nice, but must confess the truth. I was feeling sick and therefore thought to call a doctor, but I became ashamed – doctors too may be sick – thus I started writing … while we all are the humans, there are the doctors and the patients (something like two different species)… That was foolishness, isn’t it? But the comprehension of the truth helped a little. While meeting the doctor, I forget all my hardships of the disabled and joyfully welcome him to my art show.
Thus current situation confuses me doubly – while writing to you I can’t invite you to my exhibition (we live too far).
However, the distance can’t remove my respect. That’s fine indeed. Our attitude heals us and the outcome appears – you are heartily welcomed to my blog. Thank you.
Doc, as I read these musings about the system and the whole person as they relate to one’s overall health, I can’t help but think about all the people whose response to this kind of thinking would be “well, that’s all very nice, but how do you fix what’s wrong with me?!” We humans tend to see things as binary – you’re either with us or against us, you’re either healthy or your not – without recognizing that there’s precious little (if any, really) black and white in the world.
Until we can be at peace with the idea that we exist in a world of grey and that there may not BE any hard-and-fast truth, we’re never going to be able to get our heads, hearts, or spirits around the idea of holistic medicine – not really…
Ah, Tomas, thankyou for your incredibly kind comments. I wish I lived closer. What a treat it would be to visit your art show. In the meantime I’ll continue to enjoy your art on your blog.
mrschili, you’re absolutely right about the the “binary” view. I stumbled across “general semantics” a few years back and one of the points they make is what they call “two value thinking” – which is exactly what you highlight. It really is a common way of viewing things but oh how often it leads to misunderstanding and disappointment!
You know, on a day to day basis, I just ask people to tell me about themselves. I say I’m interested in who they are, not just in what disease they might have. I tell them I’m interested to hear their story and I’d say everybody has no problem engaging that way.
Arthur Frank, who wrote “The Wounded Storyteller”, describes the typical “genres” of stories that patients tell, and the commonest one in our countries is what he calls “The Restitution Story” – which is “this bit is broken, just fix it, doc, and I’ll be on my way”. This is very appropriate in acute medicine, but it really doesn’t take us very far in the treatment of chronic problems.
There’s the key, mrschili……my job, as a holistic doctor, is to try and help patients to tell a different story – not a restitution story but a hero story!
What a great post. Even though I personally have come across this situation in my own life – I had never quite thought about it in those terms.
My pain psychologist said to me several months back – What if the doctors can’t actually find out what is wrong with you? What if there is no “IT”? I thought about it long and hard, and I simply said: “Then like always, I will simply do the best I can do with the tools that I have”.
Medicine is such a vast field. Especially when you are talking in Neurology. Like snoflakes each of us is in fact that little bit unique. If we were all cookie cutters of each other it would be easy to find the answer.
Patients with PTC or IIH are victims of this problem. Each person has their own unique spinal fluid level pressure in their bodies. An average level can be guessed to a certain point taking into the factors of age and height etc., but each person is unique with the exact amount. When you are finally at the understanding that one single drop of liquid either way (too much or too little) makes a difference to your brain function you realise how difficult it becomes.
Different symptoms are felt differently. They are also expressed differently by the patient. Communication is the key, also, the patient taking a key and active role in their own health is invaluable.
Great post…. 🙂
Amber
@dvnutrix see here – http://www.iih.org.uk/ for a nice clear explanation of those two acronyms
It’s really sad that anybody’s suffering is dismissed because it can’t be explained according to a particular model. That’s partly why we need a new model!
@amberfireinus – you are absolutely right – we are all unique and diseases are expressed differently in different people