2 Questions To Ask That Are More Important Than A Diagnosis

After 30 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 70 or 80 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 under-estimate 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?

and

2) What is lacking or what does your body need to promote healing?

I would like to thank Sidney Baker and Jeffrey Bland, two of the fathers of Functional Medicine and Efrem Korngold and Harriet Beinfield , my Chinese Medicine teachers, for teaching me to think critically about these issues and for creating a model that has helped thousands of patients with chronic problems.

Frank Lipman MD, is the founder and director of the Eleven Eleven Wellness Center in NYC a center whose emphasis is on preventive health care and patient education. His personal blend of Western and Eastern Medicine combined with the many other complimentary modalities he has studied, has helped thousands of people recover their energy and zest for life. He is the author of the recent SPENT: End Exhaustion and Feel Great Again (2009) and Total Renewal; 7 key steps to Resilience, Vitality and Long-Term Health (2003).

Comments

[MSmall]

Bravo, Dr. Frank Lipman! Your words are pure common sense, yet unfortunately this approach is hard to find among medical practitioners in this country. Let's hope more health professionals start to follow your example. In the meantime, your "two questions" can help all us heal ourselves, by examining our own lives instead of rushing off to a doctor for a magic pill or procedure that will make our symptoms disappear.
Patient, heal thyself!

[sirenity]

http://www.quackwatch.org/
If you are considering 'alternatives' be sure to check carefully before you use. Many unsafe 'products' mask as 'alternative' healthcare.

@Roy 1. Nature is not a sentient lifeform that one must learn to get along with.
2. Students are being taught hygeine, healthy eating, the importance of water intake etc. Students also learn about chemicals in processed foods etc.

Also alternative does not instantly equal healthy, safe or natural.

[PalMD]

Im wondering a bit about censorship of critical comments on this post.

I'm sure that if this revolutionary new idea is strong enough, it can stand up to a little critical examination. For example, how is rebranding standard preventative care revolutionary? How do you justify the comment that real doctors aren't concerned with real causes of disease?

Because honestly, this whole post seems rather silly to a practicing MD in it's rebranding of obvious concepts.

http://scienceblogs.com/whitecoatunderground/2009/06/you_say_you_want_a_revolution.php

[TheBurdicks]

The hyenas of the health industry are circling, as the lions of Foggy Bottom bring down the kill. The smell of blood permeates the air.
Insurance smells profit as the politicians work on mandates. Big pharma smells profit in 50 million new pill takers. The AMA smells profit from more outrageously expensive interventions. And the practitioners of alternative medicine smell profit in a new chance to nose up to the feed tough with the other gorging pigs.
Nothing ever Changes. All of this blood is going to be taken from the kill. And, we, the little people, are the kill. Same as it ever was.
A famous 19th Century Canadian physician, Sir William Osler, once advised, "toss the pills into the ocean. So much the better for mankind, so much the worse for the fish". He also prescribed, “The only way to treat the common cold is with contempt.”
Could be paraphrased, “Toss the whole health care business into the ocean. So much the better for mankind, so much the worse for the fish.”
Or, “The only way to treat profiteers in health care is with contempt.”
Acute and chronic illness and injury represent failures in any system of good health. Why all this focus on failure, when we should be going back to the beginning, starting over. 90% of all potential savings in health will come from addressing the real problem which is overweight, underexercised, hyper stressed people. Prevention is the only realistic answer.

[FarawaySouth]

Toss the pills in the ocean? Would you like to go back to treating infections with hot poultices! In the 19th century there were no antibiotics, no scans, no keyhole surgeries. Women died regularly in child birth and a simple infection was a killer. You are welcome to avail yourself of 19th century health care.

[Dr. Frank Lipman - Huffpost Blogger]

No it is not about tossing the pills into the ocean, but rather using antibiotics, scans and keyhole surgery when appropriate. At the same time taking into account diet, lifestyle and all the factors that may affect someone's health. As I said in the post, Western Medicine is good with crisis care management but not particularly good with chronic problems. The best Medicine uses Western Medicine where appropriate and other modalities when appropriate.

[TheBurdicks]

I’m pleased you picked antibiotics. This goes right to the heart of my argument. My patient with meningitis gets big, broad spectrum antibiotics, maybe even the expensive new ones. Same for sepsis, or deep soft tissue infections. No regard for cost. The total bill for the entire country is no more than a few million dollars, a bargain, and one unequivocally supported by science.
But what about all the kids with “red ears”, who reflexively get the pink medicine, the sore throats treated with azithromycin, the simple abscesses addressed with cephalosporins, or the mass of viral respiratory infections subjected to a barrage of antibiotics. Not a bit of science behind any of this allopathic quackery. And the national cost is hundreds of millions, maybe a billion or more. What do we get in return for our treasury? Nothing good. Multiresistant bacteria, MRSA, CAMRSA, all rampant in our over medicated society. No change in an infection which never needed antibiotics to start with. Hundreds of millions wasted in a futile effort to rescue us from our own ignorance.
Are we better with health care, or better without? A valid question, I believe. The answer is probably out there, in science.
Better without half or more of what is pedalled as allopathic medicine, and most of alternative medicine? I am convinced the science is there to substantiate a resounding “yes”.

[mollymac]

You are much too literal. Try reading what he is really saying instead of taking it all as gospel.

[TheBurdicks]

Reform that part of the system which responds to failure. Desperately needed is Single Payer, preferably universal nationalized health care. Regulation becomes possible. Any intervention not withstanding objective, scientific investigation and producing statistically significant results is discarded as useless detritus. Half, maybe two thirds, of allopathic medicine simply vanishes. Even more of this new age mumbo jumbo alternative medicine joins allopathic quackery on the trash heap. Universal electronic medical records are imposed. The single payer negotiates a fair price for pills, potions, other interventions. Fair salaries for health care providers and administrators are set. Management is streamlined.
Modest savings will follow.
But, keep an eye on the big picture. The kill here is us. Our failure to approach good health in a systematic effort, designing quality into our individual and collective health, weakens us, makes us easy kill for the lions, fodder for the jackals.
We don’t need many pills or operations. We don’t need many doctors. We don’t need faddish diets or supplements. We need inexpensive emphasis on prevention in the home, school, workplace, and health care facility, and in our media. We need simple balanced diet, regular exercise, and stress reduction. We may spend a little more for fresh organic fruits, vegetables, and grains, for exercise equipment (walking is free!), and for coaching on stress reduction.
But the savings will be huge, and we all feel better.
We can spend less than the rest, and rank number one in health statistics.

[kkdc]

I agree. And if they can pass legislation on tobacco companies, it would be well if we imposed taxes, fines or regulations on fast food, get fast food and vending machines out of schools, have K-12 useful scientific education on taking care of your body, good diet, exercise etc, as required courses, as well as requiring daily exercise at school....get big Pharma off television, along with fast food commercials alcohol etc. Just a modest start. :)

[Indra]

I think that the most important you can ask your doctor is "How Much?".

[BlackYowe]

Good piece!

[Trelanea]

Soo having said all that.... Anyone know of a good doctor in Portland OR? :P
I am a divining rod for the verbally abusive egomaniacal ones.

Perhaps a reputable resource (website, hotline, etc.) for finding doctors who practice functional medicine? (and are preferably covered by insurance, and can deal with chronic illness....)

[Dr. Frank Lipman - Huffpost Blogger]

try http://www.functionalmedicine.org/ to find a Practitioner

[wagadog]

Oh yes, ask those questions! IF you can get him to call you back, that is!

[davidwayneosedach]

Good questions. Every body ask their physcian them.

[BlueZoo]

It would have been helpful if we were given some way to find such a doctor! A doctor who has the time to go through those two queries in detail would be a real diamond but I've never come across one. My personal experience with doctors is they either have no time for details or they don't care. It's disheartening...

[takeyourballandgohome]

Well, my best girlfriend was booked for brain surgery to remove a tumor and when her surgeon did his rounds late in the afternoon...he asked if she had any questions to which she asked "how many of these have you done" and #2, "what are going to be doing tonight?" To what he interpreted as sarcasm, his answer was "I'm going to take that out of you" and so, in her recovery, she feels it took her almost 5 yrs to get back her sense of humor...

True story...

[northstar11]

i had to have a pace maker installed --i asked the doctor how many he had done---- he said you are my second -the first didnt go to well but i think i have the hang of it.

his boss said he's kidding -done hundreds and is very good.=true story.

[decolonizeme]

Unfortunately doctors are so busy dealing with insurance claims that they often breeze in and out of exam rooms, tell you what they need to say, and dash out before you can ask any questions. Of course, the arrogant ones also take offense at the fact that you would question them at all.

When's the last time anyone had a meaningful conversation with their doctor?

[wadenelson1]

I started out pre-med. My grades were "good enough" but not fabulous.

At some point junior year I realized everyone else was out having fun socializing but the pre-meds were so hyper competitive and socially unskilled they actually preferred to spend their Friday and Saturday nights studying in the library, alone. They didn't get laid or bond with others, or form lots of social relationships.

Some would even steal books, or slice critical pages out of books in the library to deprive other premeds of access to them.

I liked people. I realized I wasn't "one of them." I wanted to help others. I became an engineer.

The result of this hyper competitiveness is MD's who are sorely lacking in social skills. The ability to make small talk, for example. Hospitals have to TRAIN many of them to show empathy.

MDs lack of social skills often comes across as arrogance. Treat them like the dweeb in 8th grade and you'll communicate much better. Their behavior becomes crystal clear, they're mostly geeks, not arrogant a-holes.

[skooch]

I completely agree with this. The example I always use when making this argument to everyone is a friend of mine who had very bad back pain. She was very overweight and out of shape and the back pain only started after she stopped exercising and gained all of the weight.

Instead of trying to get her to lose weight and exercise, which I am 100% sure would have significantly reduced her back pain, the doctors just kept giving her more and stronger pain killers. It was a ridiculous situation and I think it is indicative of how healthcare works in general these days.

[medicontheedge]

good luck with this.... we have become accustomed to the 'fast foo" model of healthcare delivery.
we want it now, we want it easy, and we want it cheap.