Key Questions

I feel like medicine these days has become obsessed with naming diseases and syndromes.  The new ICD-10 (International Classification of Diseases is the way healthcare practioners name and categorize disease) has also magnified this obsession by having more than five times as many codes as the previous iteration (ICD-9).  This also forms the backbone of how most doctors get paid through insurance companies, Medicare and Medicaid.  Patients are also overly focused on wanting to know what disease they have, and I understand this need.  This focus on the "what" of medicine often gets most of our attention.  It's thought that if we can know what disease someone has that everything else will fall into place and they will be suddenly healed.  Once a disease is diagnosed then it is matched up with the appropriate medication and away we go.  However, in this rush to know “what,” we often forget to ask other key questions.

Who is the person who has the disease?  What is their personality?  Beliefs?  These are important questions to ask because it allows the healthcare provider to know how this person will handle the diagnosis.  Not everyone will react the same when diagnosed with a medical problem.  Some will deny they have it, and others will aggressively want to change everything in their life to try to fix it.  Some people will optimistically keep going like nothing happened, and others might become depressed and shut down.  Taking the time to get to know the patient is the first step towards personalized medicine.

Why do they have this disease?  Few diseases offer a single clear-cut reason and, in fact, most complex, chronic diseases might have developed due to dozens of factors.  However, the likely reasons why a person developed the disease they have is crucial to know if we are trying to address the root causes of disease.  It is also important to ask what factors might be perpetuating disease.  In Functional Medicine we call these mediators because they may not have caused the disease but they keep it going.  Maybe the person is eating a diet that doesn't match their biochemistry.  Maybe they have had poor quality sleep for 10+ years.  Maybe they are constantly stressed and have no tools to deal with it.  By addressing why someone has disease, allows changes to be made that may help improve or resolve their disease state.

How did this person develop this disease?  What triggering event or events tipped this person from a healthy state to a disease state?  This can be the most difficult question to answer but also holds the most promise for improvement.  Often times there are many triggers that have led to a steady decline in health.  By helping the patient discover what has led them to where they currently are, a skilled doctor can start to walk them back to the path of health.  The field of Functional Medicine recognizes that many chronic diseases have similar root causes (inflammation, insulin resistance, mitochondrial dysfunction, etc).  By addressing these root causes we can start to shut the water off on an overflowing sink (rather than just continue to mop up the water as it spills over).

So, next time you go to the doctor and receive a diagnosis, try to also push your doctor to explain why and how.  Be suspicious if you are talking with any doctor who minimizes the importance of these other 3 questions (who, why and how) because this may lead to an insight that can drastically improve your health.