Overlooked Diagnosis: The Most Common Cause

The high point in my medical education was a medical school semester at a hospital in Soho, the very heart of London’s swinging ‘60s. From an academic point of view, I don’t remember much except for one compelling lecture from a very British professor on making an accurate diagnosis.

He began by saying doctors had become too dependent upon tests, x rays, and specialist referrals and that they weren’t attentively listening to their patients. He ended with this memorable (to me, at least) line, “If you listen long enough, and carefully enough, your patient will eventually tell you the diagnosis.”

Not literally, of course. What he meant was that if you, as a doctor, kept adding to your fund of medical knowledge and learned how to ask the right questions, then every word from the patient’s mouth would contribute to a successful diagnosis.

Sometime later, medical intuitive Carolyn Myss would add to what I hoped had been my own years of careful listening. Her rule was this: a patient’s biography becomes his or her biology. A person’s life story is vital to understanding what ails within.

Sadly, too many patients are falling victim to what can only be described as physician inattentiveness.

Telling their stories

Here’s an example. A patient with ulcerative colitis (UC) related her experience at a prestigious gastroenterology center. The doctor had been encouraging her to take powerful immune-modulating drugs (which do work, but at a price), but she was unenthusiastic about the side effects. During this visit, she had some good news to report to the doctor. She’d gone completely gluten free and within 24 hours felt better. Two weeks later, her pain had disappeared and her bowel movements were normal.

But instead of a supportive response, the physician barely looked up from his computer screen as he said, “There’s never been a connection between gluten and colitis. Anyway, you apparently forgot I tested you for celiac disease and you were negative. It’s just a coincidence. You can eat all the gluten you want. Really, for your health’s sake, you should start the modulator. Let me get you scheduled.”

She thought, “I guess he just didn’t hear me.” Personally, I would have thought (or blurted aloud), “What! Didn’t you hear what I just said? I just told you I think I’ve found the answer to my UC and you tell me to eat all the gluten I want.”

I’ve lost track of the number of patients who have given me variations on this theme, not infrequently with harmful consequences.

Patient: “You said my overactive thyroid was mild. I’d like to try something alternative.”

Doctor: “What? Won’t work. We’ve got you scheduled for radiation therapy. Alternatives just don’t work” (not true, by the way).

Patient: “I’ve read about adrenal fatigue and have all the symptoms.”

Doctor: “Never heard of it. Probably doesn’t exist.”

Patient: “My muscles hurt everywhere. Could this be fibromyalgia?”

Doctor: “You’re just tired and depressed. Let me refer you to a therapist.”

Chronic fatigue patients are dismissed as lazy or accused of using the doctor to fill out disability paperwork. Women with recurrent candida infections are told they’re the victims of the latest fad diagnosis.

Several endocrinologists in town adamantly refuse to prescribe natural thyroid (Nature-Throid) even if a patient explicitly tells them that they do better on it than on the synthetic version (Synthroid).

Too many physicians stare blankly, busy themselves with their laptop, or simply change the subject when a patient reports improvement with alternative therapies: a homeopathic remedy, acupuncture, herbs, or (heaven forbid!) energy healing. Some doctors are downright insulting. One patient told me her endocrinologist dramatically threw her newly purchased bottle of Nature-Throid into a wastebasket.

A splintered tale

Here’s an I-can’t-get-my-doctors-to-listen story that may have a happy ending soon. A patient with no history of skin problems was feeling fine until he got a nail-sized splinter in his finger. He almost collapsed from the pain and was taken to a nearby emergency room where the splinter was removed. But in the months that followed, he began to develop severe blistering rashes not only all over his body, but especially on the finger that had caught the splinter. He was concerned that something on the wood was toxic and continuing to poison him.

Over the next year, using standard treatment, mainly steroids, the rashes slowly improved. Nevertheless, he continued to get mild rashes and (importantly, to him at least) with every flare-up he’d get a rash on the same finger from which the splinter had been removed.

Every dermatologist had told him, “The splinter is only a coincidence. It couldn’t be causing this.”

He told me that the doctors just hadn’t listened. “They said the ER x ray was negative, but I’ve read you can’t really see small amounts of wood on an x ray.”

So we ordered an ultrasound of his finger, the gold standard for locating foreign bodies inside you. And as I write, he’s getting a surgical evaluation to remove the remaining splinter fragments.

The point of this Health Tip? If, in the presence of a doctor, you intuitively feel you’re not being heard, the doctor has a good chance of missing your diagnosis. He’s in his own world of laptop, overbooked schedule, and home life. He has his fixed set of medical school “facts” and doesn’t want hear about your alternative therapies or what you read on the internet.

If you sense inattentiveness on the part of your physician and live with it, you do so at your own peril.

Be well,
David Edelberg, MD