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How Accurate is a Diagnosis?

by Dayal Pathberiya(more info)

listed in clinical practice, originally published in issue 123 - May 2006

How often have we been sick and sought the aid of a Medical Practitioner (Allopath) or an Alternative Medicine Practitioner for treatment? An Allopath is a medically trained doctor and Alternative Medical Practitioner can be from any alternative healthcare system such as Traditional Chinese Medicine (TCM), which includes Herbs, Acupuncture, cupping etc, Homoeopathy, Ayurveda, Reflexology or any other similar types of treatment that stands apart from the standard medical system. The two streams together, are known as Complementary and Alternative Medicine (CAM).

A Diagnostic System

The patient having chosen a practitioner to consult, would find that each practitioner has his/her own unique processes for diagnosis and treatment. The result is a varying effect on patients, depending on the system. This may explain why some treatments have side effects and others not, likewise some treatments cure and the others do not. A medical doctor would probably use stethoscopes and other apparatuses and techniques coupled with scientific tests; this helps the doctor to make sense of the symptoms. The symptoms are grouped depending on the intensity, frequency and the connection to other symptoms or illnesses. On more occasions than not, the result is an administration of medical drugs or surgery to relieve the symptom or group of symptoms (illness).

This entire process of disease identification, classification, diagnosis and treatment is based on accumulated data from the past. This gathered data is then organized through logical human reasoning, to facilitate our understanding of the disorder. The results of these are then used for further enquiries.

On the other hand, an Alternative Practitioner, for example a TCM practitioner would rely on a different diagnostic system. This would include techniques such as Pulse and Tongue diagnosis as well as inspection, examination and history taking. It will also take into consideration other finer aspects such as the smell, the sound, the touch of a patient etc. This helps the practitioner to form a more detailed individualized picture of the patient in relation to his/her disorder. Moreover, the focus is not only on the presenting physical disorders, but also on a patient's total construct, which includes the mind, body and other elements. The next step would be to attempt to treat the individual in order to bring the 'disorder' into 'order'. The objective is not the treating and curing of symptoms but treating the individual so that the individual himself / herself comes to a balance and thereby cures the symptom/illness. Most alternative methodologies have similar views to TCM though they use different systems of diagnosis and treatment.

Surprising though it may seem, most refined ancient alternative systems do not tend to identify a disease by name. The reason being is that the cause of a particular symptom/illness may well be due to an underlying factor, which has not yet been dealt with. The symptom/ illness, is just the tip of the iceberg to a larger problem. To understand the actual cause of the symptoms/illness, a practitioner has to understand the individual as a whole and find what and where the imbalance is.

Though the symptoms can appear to be same in the two patients, the practitioner might diagnose two different disorders, which the Allopath may not understand. Nevertheless, consider this situation, where all the traditional medicine diagnostics are completed, alternative medicine also concludes that both patients suffer from the same disorder and have the same symptoms. However, are they identical?

Uniqueness of Individuals

Fundamentally this is not true, as they are two different human beings altogether. They have lived completely different lives, been conditioned by different climates and social behaviours etc and have consumed different food. They have grown into two completely different humans beings. They even look different. (One could be an African and the other a Caucasian)

No two people can ever be identical, nor can their disorders? For example, even though we speak English, we talk in different styles; the pace, the pitch, the power, the points of inflection, modulation etc are unique to that individual, though it might seem similar.

However, the patients seem to suffer from the same disease even though they are completely different beings. Other than the disorder, the patients have nothing in common. The disorder seems identical only because the diagnostic systems lead us to believe it. Now the fundamental question is, is the diagnosis accurate? Because it is on this pivotal point, we have come to conclude that the patients are identical. Furthermore, it is on this diagnosis that the treatment protocol we use depends on for its efficiency.

On deliberating the accuracy of the diagnosis we encounter the question, 'what is a diagnosis?' the understanding of this concept is of paramount importance if we are to 'diagnose'.

'Diagnosis' is to use a known system (rules and regulations), which is identically applicable among all human beings, to attempt to see through this system in order to ascertain the deviations from the system's norm in a human being.

Furthermore, 'treatment' is to look through a system, which is identically applicable among all human beings and attempt to influence the human being (patient) so that the abnormalities, which were found in the diagnosis in reference to the system, are brought to an acceptable state according to the system.

Both diagnostic and treatment systems have been developed for our ease, through the interpretation of our perceived world. So seemingly complex, incomprehensible, dynamic, 'real world live objects' or processes can be simplified into understandable fragments. These fragments of knowledge are not enough to be used to comprehend the actual. Therefore, our understanding of any of the 'real world objects' or processes is never complete, and any judgment we make with it is incomplete. This lack of complete understanding not only applies to the diagnostic and treatment process, but is also mirrored through our other efforts to mimic the real world, such as Artificial Intelligence and computers.

By simplifying, we have lost the true meaning of things. Thereby we have created an inaccurate tool. However, the word inaccurate seems a bit too harsh. Because the system might have some truth in it, as it might be able to imitate/influence some aspects of the real world (the human being or any other) but not all aspects. It is safe to say that all systems have a degree of inaccuracy. This applies to even diagnostic and treatment systems.

A Flawed System

Having defined that, we come back to our two patients. They have been diagnosed with an identical disease by Complementary and Alternative Medicine (CAM). As you can see, the cause of the problem is the system that we have been using. All systems are inherently flawed, because they are limited. Therefore, they are unable to understand/know the whole problem or the true cause. Since the systems are limited, the diagnosis, the treatment or any other function of the system is not complete and therefore inaccurate.

That which is apart or beyond the limits of the system cannot be taken into the equation. When we speak of any system, the word itself means that it is trapped and restricted. Therefore, the practitioner who uses any system would only be able to know one or a few limited aspects, and not the being as a whole. That which is unknown is left out completely or left for imagination to weave as it pleases, resulting in fancy tales as the cause of a disease.

Depending on the diagnostic system used, different practitioners might reach different conclusions as to the cause of the disorder. Therefore, the treatment also could vary. As you see there exists a fundamental problem. Any diagnostic system, however old, profound or scientific is limited. It is limited in the approach to understand the disorder and limited in the way they influence the disorder. There is always that which we are not aware of and have not taken in to account. In spite of our efforts to be in control and be aware of all that occurs and influences a person's body, we have failed, as unknown factors have always overwhelmed.

The good thing about Allopathic Medicine is that it is still growing but it never will be able to understand the 'whole'. This is because there never can be a movement from the known to the unknown. However, most Alternative Medical Practitioners believe that the learning/growth of the subject, especially ancient alternative medicine systems such as TCM, Ayurveda, Reiki etc has ceased. The only thing left is how best one could learn from pre-existing knowledge.

Coming back to our patients, how best can we bring them to normalcy? So far, the main problem that arose from the diagnosis is its accuracy. The cause of this imperfection is the use of rules and regulation (however elaborate). The methodology (system) used is fixed. In the sense it is a generalization and not dynamic. This means it cannot always know the state of the patient at a point in time as the state of any being is ever changing. So is it actually possible for a CAM practitioner to offer a customized diagnosis, let alone treatment? Is there a way in which all possible aspects that need to be known are known, so that we could offer a complete cure? Can we ever do justice to those who seek our help? This may be the reason why some patients are less or non-responsive to treatment be it any type of treatment.

However, the important question is whether we can really be bothered. We know our treatment on certain occasions does not have an affect on some patients or on some conditions or helps only for a short time etc. We are also aware that the treatment available has room for improvement, to better assist the patients. Nevertheless, the truth is that most of us are not bothered, are too lazy or we dislike change.

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About Dayal Pathberiya

Dayal Pathberiya trained in acupuncture, acupressure and homoeopathy at the Open International University for Complementary Medicine, Colombo, Sri Lanka. He has co-authored the book Clinical Auriculotherapy with Prof. Anton Jayasuriya. He may be contacted via dayal_pathberiya@yahoo.com

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