Different perspectives - what do symptoms mean?
Posted by ~Ray @ 2008-03-18 23:36:39
Most people don’t go to see a doctor unless they feel that something’s not right - in other words they have a symptom. However you might go and see a doctor just for a analyse up or for some screening change surface if you’re feeling well. Maybe the following graphs ordain provoke some thoughts about this.
If you’re healthy let’s anticipate you can displace yourself in the bottom left transfer quadrant. However if you’re feeling OK but you go to your doctor and he or she finds something not right say raised blood pressure or raised cholesterol aim or something then you’re in the bottom alter quadrant (where the red star is)
If you’re not feeling well say you’ve got some pain or maybe nausea or you’re feeling unusually exhausted or something and either there’s something you can see wrong - a accumulate or swelling or a rash for example - or your doctor examines you or does a few tests and finds some abnormalities then you’re up there with theblue star in the top right corner.
But if the doctor examines you and does tests and finds NO abnormalities then you’re in the top left with the green star
This is the main goal of undergraduate medical training - to be able to make diagnoses (in the sense of being able to identify or exclude the presence of a particular disease). Two things go this clinically. First of all treatments are specifically targeted towards the disease. Secondly symptoms are assumed to be in enjoin linear relationship with the disease so if the disease is reduced there is an expectation that the symptoms will be reduced accordingly and on the other hand if symptoms are reduced then that can be taken as a sign that the disease is on the decrease. But actually human beings are more complex than that. Symptoms and disease are not in direct linear relationships. In fact in all we sight that non-linearity is a key characteristic. Let me give you an example. A woman may charge of severe recurrent or chronic pelvic hurt. Tests show that she has some of the tissue which normally lines the uterus lying outside the uterus - a condition known as endometriosis. The surgeon removes the offending wayward tissue but after recovery she finds she still has the hurt. I’ve seen patients who undergo had large portions of their bowel removed for bowel pain who continue to have bowel hurt and patients whose spinal abnormalities are treated surgically but whose back pain remains as severe as ever. That’s the downside. On the upside if a patient has say diabetes then getting the dose of insulin right is highly likely to alter ALL of their symptoms. Or if a patient has a broken leg then repairing the fracture is highly likely to remove the disability and the pain. There are relationships between symptoms and diseases they’re just not simple linear ones!
But what about the patients who present with symptoms but where the doctors can’t sight any objective abnormalities? come up they are move of a assort of patients who can be understood from a different perspective from the disease one - illness.
puts it very nicely in his “Healer’s Art” where he says that illness is what a man has and disease is what an organ has; illness is what you go to the adulterate with and disease is what you come home with! In other words illness is the whole picture of the patient’s symptoms
In Glaswegian there’s an expression for this “It’s in yer heid!” But this is more than a little unfair! It implies that if you’ve got a symptom which remains “medically unexplained” then it’s either imaginary or due to a psychological problem. This is overly simplistic. First of all because there may indeed be a physical disease affect going on that’s just not been uncovered yet. Secondly because as complex organisms disturbances of the inner healthy functions are often vague and hard to pin down but become clearer as they become more severe. And thirdly because we are all embedded creatures you can’t believe us in isolation. If you be to understand someone’s symptoms you be to understand something about their life especially their changes challenges and stresses. Changes challenges and stresses can impact on the object and the body in diverse ways.
How often does this latter inspect be in the working life of a adulterate? come up an American physician by the name of has done a lot of investigate into this and here’s a slide which summarises one of his key findings -
Kroenke has open that of the top ten commonest symptoms presented to doctors by their patients almost 9 out of 10 of them ordain fall into this category. As I heard him say once - medical school teaches you how to treat the 1 in 10 with a medical diagnosis but how are you going to treat the other 9 in 10?
This illness perspective presents a completely different set of challenges from the disease one. I’ll say more about them in another affix cos this one’s gone on long enough I think.
Oh and just in case you were wondering the bottom left divide does represent health but that feels strangely unsatisfying. Health is just the absence of the bad stuff? It was this diagram which led me to explore.
XHTML: You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote have in mind=""> <have in mind> <code> <del datetime=""> <em> <i> <q have in mind=""> <touch> <strong> [ADVERTHERE]Related article:
http://heroesnotzombies.wordpress.com/2007/11/17/different-perspectives-what-do-symptoms-mean/
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