Making a Diagnosis is Less Important Than Asking These 2 Questions
After thirty years of practicing Medicine, I have learned that for any chronic illness or ailment, treating underlying imbalances and dysfunctions is more important than making a diagnosis and naming the disease. Ultimately, asking the right questions is more important than giving a label to a set of observations.
This is because most if not all chronic problems, from heart disease to arthritis, migraines to irritable bowel syndrome (IBS), depression to fatigue, usually have multiple factors that need to be addressed—this is called the total load. The total load is the sum of the factors that influence a person’s life and health, including diet, exercise, job stress, relationships, state of mind etc. Individually, each of these elements might not cause a problem, but their cumulative effect can overload our normal functioning and cause harm. Everyone’s tipping point is different and each of us manifests or experiences overload in our own unique way.
For example, several patients may all be diagnosed with IBS but the individual factors underlying their illnesses may be varied, meaning that each requires different treatments to address their specific problems. Simply diagnosing these patients with IBS, obscures this critical fact.
When working with patients, I always assess their total load and then try to reduce it by slowly removing the factors that could cause harm. At the same time, I will add new elements that will nourish them in order to enhance the healing process.
Some examples of what may need to be reduced or removed from your diet are, sugar, chemicals, caffeine, or alcohol. Or you may need to lessen the burden of responsibilities, your work load, or how much tension you carry in your muscles. Examples of factors that may be lacking and need to be added are nutrients, sunlight, sleep, down time, play time, love, or joy.
To understand the concept of total load, think of yourself as a ship floating in the water. Depending on the load you’re carrying, you are either riding high above the waterline or sinking beneath the waves. And just as you can save a sinking ship by tossing some ballast overboard to lighten the load, your health can be improved by reducing the overall number of factors that cause stress to your system. The good news is that frequently you may only need to identify two or three factors to toss overboard in order to feel better.
Unfortunately, I, like all doctors was never taught this at medical school. Instead, we were taught to “name it, blame it, and tame it.” That is to look at the symptoms, signs, and test results, make a diagnosis, name the disease, and treat it.
This model works well for the acute or short-lived illnesses that were most common until about seventy or eighty years ago. There is no better model for crisis care management, such as a heart attack or burst appendix, a broken bone or an acute bacterial infection like pneumonia. Due to the incredible success of antibiotics in treating most infectious diseases, we have extrapolated that model, looking for a single cause with a magic-bullet treatment, and adapted this thinking to all diseases.
But most complaints today are not acute illnesses, rather chronic problems, which are not served well by this model in which varied complex disease processes are reduced to a single diagnosis. Giving a set of observations a name and treating the named problem does not help us understand the origin of the problem and its causes, which are usually multi-factorial. This name-it, blame-it, and tame-it medical paradigm is not particularly effective for the chronic diseases which are so endemic today.
I want to make it clear, a label or descriptive name for a problem is not a bad thing—it is often reassuring to know what we have. I do not want to underestimate the significance of this. But we have been habituated to assume that if we know the diagnosis and the name of our disease we will know how to not only treat it, but fix it.
Unfortunately, this is not true. Doctors are increasingly practicing from the vantage point of an outdated and ineffective model, and are not addressing the needs of the millions of patients who come to them with complicated chronic problems. They give them drugs to suppress symptoms and do not address the underlying physiological imbalances that produce these symptoms. Therefore we do not change the course of the disease and often end up causing more harm than good because the underlying problem persists, and many people develop side effects from the drugs.
Luckily for all of us, there is a new little known science-based model for chronic diseases, called Functional Medicine that deals with the underlying causes instead of just suppressing symptoms. It is a true mix of Chinese and Western Medicine. This new medicine is systems-based biology rather than disease-focused. It redefines chronic disease as a functional alteration in the physiological network that requires a systems biology approach to its management, improving both the safety and effectiveness of treatments.
This model helps us understand how the disruptions of molecular pathways cause dysfunctions in various body systems that then result in disease. It is less concerned with a diagnosis and more concerned with the underlying dysfunctions that lead to the symptoms and the disease.
My Chinese Medicine teachers taught me to think of myself as a gardener when I see patients. When a plant or tree is not growing well, when the leaves are drooping and turning yellow, we do not call it yellow leaf syndrome and paint the leaves green or cut off the sick part. The gardener evaluates why the plant is not growing well. He determines whether the plant is getting enough or too much sunlight, enough or too much water, is the soil rich and balanced in order to nourish the plant? And he looks to see if the roots are being impinged upon, and if so, what needs to be removed.
Even though you may have been given a diagnosis, always ask these two questions with any chronic problem:
1. What is harming you and needs to be removed to permit the body to heal?
2. What is lacking or what does your body need to promote healing?
Dr. Frank Lipman is an acclaimed Integrative Physician and the founder and director of the Eleven Eleven Wellness Center in New York City. For over 20 years his personal brand of healing has helped thousands of people reclaim their vitality and recover their zest for life. Focused on sustainable wellness—instead of quick fixes—he offers patients a customized blend of Western medicine with acupuncture, nutritional counseling, vitamins and herbs, relaxation techniques, physical therapy, and bodywork. In 2010 he developed Be Well by Dr. Frank Lipman, a line of leading-edge supplements and health programs. He is the author of Revive: Stop Feeling Spent and Start Living Again and Total Renewal: 7 Key Steps to Resilience, Vitality and Long-Term Health.