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“Sherlock Holmes” Will Diagnose You Now

“Sherlock Holmes” Will Diagnose You Now
“Sherlock Holmes” Will Diagnose You Now
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The intense, questioning, never giving up way Sherlock Holmes goes after the bad guy is the same way we doctors go after your diagnosis. And the reasoning is simple. The diagnosis is what it’s all about in the medical world. Even though it’s simply a label, it decides everything. It places you and your symptoms into a group that doctors have seen before. It allows doctors, based on what‘s happened to this group, to make a guess, a good guess, of what’s likely to happen to you in the future. This is called your prognosis. And of course, a diagnosis tells us what treatments might and might not work. Since medical school it has never ceased to amaze me how much relief patients get when a diagnosis is finally made – even when it’s bad news. It seems there’s nothing worse than being in the dark when you’re sick.


So, how is a diagnosis made? Even in 21st century America, it’s still more art than science. And in many ways we’re sleuthing for the truth as any great detective like Holmes would. Traditionally a diagnosis is based on the story you tell your doctor—in other words, your symptoms. Next up is the physical exam, followed by tests, culminating in your doctor making up a list of the possibilities that might be causing your symptoms. This list of possible diagnoses is called your differential diagnosis.


Sir Arthur Conan Doyle, a 19th century eye surgeon, immortalized this step-by-step approach to diagnosis in the legendary Sherlock Holmes detective stories. In each adventure someone (think patient) needing Holmes’ help arrives and tells their story. Holmes “questions them” about the events. In other words the “patient” tells what’s wrong, what happened, and the “doctor” takes a history. Then Holmes goes to the scene of the crime to collect evidence – in other words “he examines the patient.” Next, he collects evidence from the crime scene and sends it to the lab for analysis. In the medical world we draw blood and send it to the lab. At that point Holmes is armed and ready to theorize about what went down, who did what and name the “bad guy.” This is Holmes’ version of the differential diagnosis. In the medical world “the bad guy” of course is your diagnosis.


It may alarm you that the medical world hasn’t changed its method of diagnosis since Holmes’ day back in Victorian England but of course we have. Admittedly our process is the same but the tools we have to “interpret” your symptoms would even be beyond the great Sherlock Holmes’ imagination. Even in my twenty years of practice, scanning, CT, MRI, PET and minimally invasive scopes to have a quick look around your body have changed everything. Long gone are the days when we operate on someone to see if they have cancer and how far has it spread. With these scans we can see inside your body, increasingly in 3D, without actually being inside your body. The kind of stuff the Victorians would have thought was black magic. But it’s not. It’s real. And it’s now.

With all this new fangled imaging, does this mean that you telling your doctor your symptoms is less important now than back in Victorian England? Absolutely not! What you tell your doctor and how you tell it in the first few minutes of your encounter decides it all – how accurate his diagnosis is, how quickly he makes the diagnosis and how many tests he orders. All of which have profound consequences for you. If he goes down the wrong path and misdiagnoses you, this might well be catastrophic and cost you your life. In a more mundane way he may end up ordering more tests and scans. This of course can be really unhealthy to your pocket book but it can also be bad for your health. CT imaging uses a ton of radiation and the worry now is the over use of these scans is causing cancer.


So, what’s my advice? Tell your doc what your symptoms are in the same way you talk to a buddy in a coffee shop or bar. Forget Internet-found diagnoses. They’re simply distractions. Remember if you say Web MD says my belly pain is appendicitis. This’ll automatically result in you getting a CT scan with lots of radiation whether you need it or not. Don’t lie – if you do drugs or it burns when you pee because you’ve been with someone other than your “official” partner, ‘fess up. The doctor is there to help. Help him to help you by simply telling the truth. Always keep this in mind: you decide your diagnosis, NOT your doctor.

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