Archive for the 'Progress Notes' Category

This is Not Health Care

We use the word health rather loosely in America today. Especially the expression health care, whether you spell that as one word or two, is almost an oxymoron.

Health is not simply the absence of disease, even less the pharmaceutical management of disease. The healthcare “industry” is not the major portion of our GNP that it is because there is a lot of health out there, but the opposite. What consumes so much money and generates so much profit is, of course, sick care. The sicker people are, the more money is spent and earned in this market segment. It is a spiral, and a vicious one.

Health is a naturally occurring phenomenon, a state of perfection. Modern life has corrupted many natural, self-healing biological mechanisms and upended the natural order of things in our bodies – just the way it has altered our environment.

Our bodies are pretty ingenious in their ability to heal. When I crushed my finger in my garage door a few years ago, my disfigured fingertip, bisected nail and contused nail bed slowly regained their original shape, almost like a lizard grows a new tail. Yet in an opposite scenario, a person with scleroderma can lose their fingertip to gangrene without physical injury because of what we call autoimmunity – instead of self healing, our bodies can engage in self destruction. My fingertip could heal perfectly but some people’s skin or stomach ulcers fail to do so.

We intuitively seem to have accepted that, most of the time, nature takes care of itself if we don’t mess with it. And when temperatures rise, forests burn or species go extinct, we are quick to assume our industrial or agricultural processes are the cause.

Yet, we have this head-in-the-sand view of disease that it is a random occurrence, the sudden manifestation of ancient and rare genetic glitches or I don’t know what. The real answer is that much of it is a consequence of what we eat and otherwise expose our bodies to – how we produce and refine food, how we alter its natural properties and how we over- or under-consume basic nutrients.

Functional Medicine asks and answers many of these questions and promises to be the future of medicine. I believe in this, but I also believe that the sick-care industrial complex is powerful enough to severely slow down this revolution. I also believe the food industry will double down its efforts to continue misleading the public.

Functional Medicine cannot charge MRI scale fees for telling people to simply follow an ancestral diet, so corporate medicine will never fully embrace it.

Functional Medicine, I believe, will grow slowly and steadily as a counterculture and somewhat of a cottage industry. But then, once it gains enough momentum, maybe the “industry” will want to pay some homage to it in order to stave off the revolution that could lead to its own demise.

I fully expect corporate medicine and the pharmaceutical industry to offer healthy sounding shortcuts, like healthy eating in pill form and fecal transplants for exorbitant fees when the natural ways seem too time consuming or boring. But I seriously doubt that we will see decreased sick care spending in the next 100 years.

But I do think a growing portion of Americans will lessen their faith in traditional “health care” and live more consciously, experience better health and alter some of the disease statistics that have seemed to worsen so much just during my 40 years in practice: diabetes, obesity, heart disease and many cancers.

The Art of Triage: What’s the Worst Thing This Could Be?

Last week I became involved in two situations of pain between the eyes that seemed to potentially be presentations of very serious medical conditions.

Autumn took a call from her sister late on Friday afternoon. Her sister had been tested for Covid the day before and told Autumn she instantly felt a severe pain between her eyes and developed a nosebleed as soon as the nasal swabbing was completed. The nosebleed stopped, but the burning pain at the bridge of her nose had continued in spite of over the counter pain medications and the passage of 24 hours.

It was obvious that whoever did the nasal swab was under the impression that human nasal passages run upward at the same angle as the nasal bone and not horizontally. It was obvious that this had caused pain and a nosebleed. But the amount of pain seemed dramatic. I don’t know Autumn’s sister very well, but she never seemed melodramatic to me. I asked to talk to her myself.

“Do you have a nasal discharge from that nostril?” I asked.

“Yes”, she answered. “Constant.”

“Is it clear?”

“Yes.”

All I could think of was a cerebrospinal fluid leak. This can happen with nasal trauma, I knew, and a quick Internet search even turned up a case of this happening from a nasal swab for the coronavirus.

“You’ve got to go to the ER, and you need a CT scan”, I told her. Autumn told her she’d meet her there. I asked her to keep me posted. By 8 pm the scan was done and reported negative by the NightOwl radiologist, working in a different time zone. Autumn texted to me that the ER doctor called it a contusion. I wasn’t sure exactly what that was supposed to mean – a contusion of what, exactly. But I had done what I could and did not feel I overreacted by telling her to go to the ER.

The very next day I saw a young man with a pain between his eyes that got worse when he leaned forward. He also had decreased libido and mild erectile dysfunction, all for about two weeks. He had no nasal discharge, no visual disturbance and nothing abnormal on ENT or neurological exam.

My thoughts went to a pituitary tumor or a brain abscess from a sinus infection, but perhaps he was just feeling under the weather from an ordinary sinusitis. On a Saturday with no option for a same day CT except if I sent him to the ER, I prescribed a strong antibiotic and cautioned him to seek care if anything got worse or if all three symptoms didn’t clear after a few days of the antibiotic. After all, I told myself, his symptoms had been stable for some time and a few days would probably not alter the course of events.

Whether we take a phone call or see a patient in the office without any availability of diagnostic tests, sometimes all we do is triage and best guessing.

I slept soundly both Friday and Saturday night.

As the old adage goes: Medicine is a science of uncertainty and an art of probability.


Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

BOOKS BY HANS DUVEFELT, MD

Top 25 Doctor Blogs Award

Doctor Blogs

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Mailbox

contact @ acountrydoctorwrites.com
Bookmark and Share
© A Country Doctor Writes, LLC 2008-2020. Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.