MEDICINE'S EMPTY TOOL BOX

MEDICINE’S EMPTY TOOL BOX

by Steven Goldsmith MD

The row of hospital cribs, maybe ten, stretched along a wall of the ward. An identical row stood against the opposite wall. In each lay an infant. A full house, all patients of Dr. K. Hovering above them, a pungent odor hard to define—untended diapers?; disinfectant? A tableau redolent of a dystopic horror tale. At each visit my gut sank to witness it. But the only one who truly mattered to me was Lindsay. She, like the others, lay in arm restraints so as not to dislodge the feeding tube taped to her nose. Six or seven months old at the time.

Her mother and I had brought her days before to consult with a top pediatric gastroenterologist in Boston after her appetite disappeared and she failed to gain weight. Dr. K specialized in treating youngsters with failure-to-thrive syndromes similar to Lindsay’s and had achieved professional cachet for discovering that esophageal reflux (the leakage of digestive fluids upward into the food tube) was the culprit in many such cases. Treatment involved tube feeding.

During the consultation Dr K performed a cursory interview and physical exam interrupted multiple times by phone calls. He ordered tests, including blood work and a stool specimen to rule out a parasitic or bacterial infection. When they revealed nothing of note, he opined that Lindsay’s was a case of esophageal reflux and advised hospitalization. Also that we should cancel our upcoming family vacation to Florida.

After several days my wife and I couldn’t bear leaving Lindsay in that hellhole any longer and we insisted upon her discharge. But we agreed to administer tube feedings at home, a bummer of a prospect, and drove her home to what seemed a life of chronic illness.

But Lindsay’s fate was about to change. Prior to her hospitalization I had collected three separate stool samples from her and submitted them to a local hospital lab to rule out a parasitic infection. Because in med school we had learned from our tropical diseases professor that three such samples, not one or even two, are necessary to rule out parasites. The lab now reported one of the samples to contain the parasite Giardia lamblia, a well-known cause of G-I illness.

When I reported this to Dr. K, he expressed disbelief in the finding. But after I forwarded to him the report he grudgingly prescribed an antibiotic for the Giardia. We began the medication, fired Dr. K, and went to Florida, where Lindsay completely recovered.

What can we infer from these events? In the narrowest interpretation, Dr K viewed every patient, unless proven otherwise, as a nail, i.e. a case of esophageal reflux; and for each he wielded the same hammer, nasogastric feeding. Otherwise his tool box stood empty except for ample compartments of arrogance and cognitive sloth. But Dr K did not invent these habits. Rather, they are how our medical training taught us to think.

Consider the name of our profession, medicine. It is not coincidental that the same noun denotes our major product—and for a number of physicians their only product—medicine, aka the prescribed synthetic pharmaceutical. The medical profession could not exist in its current form without the wholesale prescription of pharmaceuticals. It knows little else besides the occasional surgery and radiation to help people. Medicine is at once our profession’s name, its identity, and the sole hammer it wields from its mostly empty tool box.

But the impoverishment of medicine’s tool kit extends further than the blinkered infatuation with pet diagnoses or pharmaceuticals. As noted, Dr K diagnosed Lindsay’s “case” of esophageal reflux. Thinking of complex, unique human beings as cases has doomed medicine to mediocrity. Let’s say your doctor has just diagnosed your case of “spontaneous idiopathy”. (Don’t bother googling this term as I invented it. Idiopathic is medicalese for disease of unknown cause. Spontaneous idiopathy would be a disease that happens for no known reason and with no known cause. Like all the athletes and children dropping dead for no reason after they got Covid shots.) As a case of spontaneous idiopathy (known as SI by jaded clinicians), you share a constellation of signs and symptoms with all those similarly diagnosed. If you differ from those others in countless other ways—other medical history, life history, temperament and emotional issues, job, family, likes and dislikes, talents, hobbies, relationships—no matter, you are all cases of SI, requiring by definition similar treatments, i.e. the same hammer, and bearing similar prognoses.

In this manner, case-oriented medicine, i.e. mainstream Western medicine, erases your individuality, your identity as a whole person. Treatment that abolishes the symptoms of a case is deemed a success even if the rest of the patient remains unwell or even if underlying causes are not addressed, as they rarely are. Because as my previous Substack posts (see “Psychiatric Diagnoses Are Bad for You”, Parts I-III) discussed, the only way for healers to help people become well is by stimulating the self-healing resources of the whole person. We can see why medicine has such an abysmal track record, as witness the ever-increasing burden of chronic illness in our society (see my book, The Healing Paradox for further details of this calamity). Thousands of times daily throughout the West, by treating cases instead of people, it violates the precept of Dr. William Osler, a revered father of modern medicine: “The good physician treats the disease; the great physician treats the patient who has the disease.”

Be well.

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