Limitations of Diagnosis

As new illnesses emerge, especially the multi-symptom problems of food-related illnesses, their victims pass through a limbo of ignorance and misunderstanding, lasting years. Patients I have seen have a combination of health problems, extending over a long period. They often complain of disturbances in many parts of their body. Their symptom list is long and perplexing. In terms of our well-established diagnostic entities, these common disorders are not understood and may be called ill-defined-illnesses. A sick patient who does not fit into a standard diagnostic category tends to be ignored or dismissed.

When a patient falls into this diagnostic limbo, curious things begin to happen. A number of "diagnostic default" explanations are often offered by physicians instead of proper diagnoses. Stress, tension, colds, flu, viruses, or references to psychosomatic illness are the favored defaults. Psychiatric diagnoses such as "depression" and "somatization disorder" are descriptions that often conceal the real nature of illnesses. These obscure illnesses may be food-related and when they are, the solution is diet revision, not drugs.

Medical diagnosis is a difficult task that combines intellectual and intuitive skills. Well-defined entities with structural changes in tissues are the easiest to diagnose. Most medical technology addresses these needs. The specification of coronary artery disease, for example, can be precise and is a tribute to the combined effort of physicians, technicians, engineers and equipment manufacturers to fully reveal a disease process. The precision of these well-defined areas of medical concern may mislead the unwary into thinking that all areas of medicine are equally well defined or can be well defined with just a little more effort; however, most disease processes remain obscure and are genuinely difficult to characterize and understand.

Common syndromes are diagnosed on clinical grounds often with no objective evidence whatsoever. While the history of migraine headaches is distinctive and an astute clinician can make the diagnosis on history, the emergency room physician will have trouble deciding whether a patient with a migraine story is really suffering pain or simply wants a narcotic drug. The diagnosis of depression is another subjective syndrome that requires a historical understanding more than positive lab tests. The irritable bowel syndrome is also diagnosis of exclusion. The patient may suffer a great deal but tests are repeatedly negative. The list of ill-defined syndromes is long. A shift from category diagnosis to understanding the process of disease is helpful to understand the patient but is often not acceptable to agencies that pay the bills. The insistence for a disease category works against progress in understanding disease, simply because everyone wants to know what this is called and not where it came from and how to prevent it from happening.

Without a well-equipped research laboratory, it will not be possible to actually measure the disease-causing events. The patient's symptom reports and a general understanding of pathophysiology will usually suffice to construct an adequate theory (diagnosis) and prescribe effective intervention. Often a burst of symptoms, emerging over hours or days, can be explained by antigenic material from food entering the circulation from the gastrointestinal tract and triggering a variety of alarm and defense procedures. We propose a process interpretation of dysfunction over a category definition. In other words, I am more inclined to ask, "What is the source of the problem and how does the problem develop in the body over what period of time?" These are more useful questions to answer than, "What is the problem called?" If we know more about the way of the disease, then we are better equipped to alter its progression, especially by removing its origin.

Pragmatic, primary medicine is especially difficult because of the wide range of disorders that present in all stages of manifestation. The primary physician faces a nearly impossible task. He or she must deal with patients with common syndromes that lack objective specification, with early illness that may eventually become well- defined, illnesses that are already well defined, mingled with injuries, infections, addictions, psychosocial problems and patients who just want money from insurance and disability claims.

You could argue that primary physicians do well, considering their demanding tasks and their limitations. However, several well-defined diseases that respond well to diet revision are not properly managed by physicians. These include asthma, diabetes 2, Celiac disease, Crohn’s disease, obesity, arthritis, hypertension, arterial disease and alcoholism. These problems and others require self-managed care as the primary method of treatment. The patient, not the physician should be in charge. The physician’s role is to provide back-up support, laboratory monitoring and the prescription of medication when needed.