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Sun, Sep 21, 2014

Dr. Kestner: What if your diagnosis proves wrong?

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Most of us grew up with the idea that if we experience symptoms that were troubling, we should go to “the doctor” and the doctor would look at us, poke around, tap our knee, listen to our chest, perhaps draw some blood or take an x-ray, then confidently make a pronouncement of what is wrong with us.

The doctor would write a few unintelligible words on a piece of paper, we would take it to the pharmacy and we would receive the magic concoction that would “make it all better”.

Somewhere along the line as we grew into adults we began to realize that dream doesn’t always match reality. Although in many cases the events related to illness unfold as described above, in many situations that scenario has no bearing upon reality at all.

Have you ever watched one of those television shows about mystery diagnoses? In most cases, the mystery illness is finally identified in the end by an astute doctor or clinician after possibly decades of improper treatment or no treatment at all.

Well, that sort of thing happens. Human function is so diverse and complex that people are misdiagnosed every day. This isn’t because the doctors aren’t competent. It is often due to the fact that so many symptoms can be caused by an extraordinarily diverse range of illnesses and conditions.

I once heard a lecturer tell the clinicians he was teaching, “Doctors, keep in mind that anything can cause anything,” Over the years as I have encountered patients with troubling stories of difficult diagnoses it seems that he was correct.

Take a headache for example. Most headaches are caused by fairly benign conditions such as excess muscular tension, sinus pressure, spinal problems, increased blood pressure, blood sugar irregularities, hormone imbalances, or similar routine conditions.

However, headache could also be the first sign of many serious disease processes. On my bookshelf I have several texts devoted solely to diagnosis or treatment of headache. There are doctors that specialized in nothing else except headaches that are not easily diagnosed.

So, if you have a headache, or any other bothersome symptom, how do you know that you will receive the correct diagnosis when you go to see a doctor? In some cases, you don’t.

There is an old adage that the only absolutely correct diagnosis occurs during autopsy. Due to the overwhelming complexity of the human body, diagnosis is often a game of chance. When presented with a patient that relates a specific set of symptoms, in many cases, the doctor making the diagnosis will end up with a probability rather than a certainty.

In other words, rather than saying with complete confidence that the problem is unequivocally this or that, the most accurate statement would be that the symptoms are likely caused by this, but it’s possibly that.

In most cases, this probability technique is satisfactory. The doctor will be right more times than wrong, and when he or she is wrong, the next effort will be more on target.

But what if you have been to your doctor and don’t seem to be making progress at all or getting worse … what should you do?

My first suggestion would be to return to your own doctor and let them know that you think that either the diagnosis isn’t quite right or the treatment isn’t working. For one thing, they need the feedback regarding results and for another that is often your best chance to get things straight.

If you still don’t feel that you are on the right track, it might be time to seek a different opinion from a different doctor. Sometimes it is wise to turn to a different kind of specialist altogether. A different doctor may well take note of something the first one missed or have a completely different view of the symptoms.

The one thing I wouldn’t recommend is to give up and ignore significant symptoms because you are frustrated that you didn’t get help with previous efforts. For most problems, there is a possible solution.

Next week: I’ll share a story about a patient that found a great way to handle stress.

Dr. Mark Kestner
mkestner@DrKestner.com
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Dr. Mark Kestner, Living Well, Voices
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