Sunday, September 21, 2008

Do Not Forget the Patient: Tyranny of Diagnosis

Do Not Forget the Patient: Tyranny of Diagnosis

From "DB's Medical Rants" opens with this quote:

The concept of disease, Professor Rosenberg writes, has historically focused on the individual — a single person’s experience, story and sense of meaning.

Over the last century and a half, however, medicine has increasingly decoupled disease from the individual. This decoupling has given rise to the concept of precise, objective and quantifiable diagnoses, diagnoses so separate from patients that they seem in many ways to take on a life of their own.

Diagnoses cluster together by specific physiologic mechanisms, signs and symptoms, pathologic findings. They have insinuated themselves into health care economics as DRG’s, or Diagnosis-Related Groups, which drive physician compensation. They have inspired whole subspecialty training programs and huge advances in how we understand and treat them. Think of heart failure, cancer and my own specialty, liver transplantation.

This greater understanding and improved treatment are important and good news for all, no doubt.

Yet along with these great clinical strides, diagnoses have also fomented their own cultural revolution. Diagnoses have changed the way we approach individuals."

His summary: "Great physicians treat patients. We need to refocus medical care on patients, while considering diagnosis as an important but not a trumping factor."

Marina: What are your thoughts?

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Books on Doctors as Patients and a few on the Doctor-Patient Relationship