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The trouble with treating symptoms and not the cause

Reading time: 3 minutes

Doctors are supposed to inspire confidence. After all, you want someone on the other side of the table who is quietly reassuring and in control. Someone who might say: “Yes, I can see you’re close to a complete meltdown, but I can handle this. I’ve got this one covered.”

And in that moment, you think this person can answer any question, from “Why do I have this disease?” to “Will I be all better very soon?” You even suspect there’s a ready answer to the more metaphysical questions, such as “Does life have meaning, or are we born only to die on a soulless piece of rock created by chance in an indifferent and cold universe?”

They’re all good questions – although the last one may be stretching things a little. If you do understand the causes of a disease, you’re better placed to treat it and help the patient recover, after all.

Sadly, this is where the mask of reassurance drops. It’s estimated that medicine doesn’t have a clue about the cause of nearly half of all diseases that doctors encounter day to day.

Wikipedia devotes 80 pages to “ailments of unknown cause,” and includes Alzheimer’s disease, atherosclerosis (hardening of the arteries), and attention deficit hyperactivity disorder (ADHD) in the list – and the keen-eyed of you will notice that’s just the A’s.

Go down to H and you’ll see hypertension, or high blood pressure. In 90 percent of cases, medical students are taught there’s no known reason why someone has it. Too much salt? Not really. Stress? No, that doesn’t explain it. Drinking? Nope. Smoking, then? Not that, either.

But we can’t have doctors telling patients that they don’t have a clue why they have some condition. The very fabric of society would be torn asunder. So they hide it with clever terms or some medical gobbledegook.

For high blood pressure, the doctor will probably write on the prescription pad: “Essential hypertension.” Reading it, the patient may even feel a tinge of pride. My hypertension isn’t one of those unessential types; it’s essential, and it probably plays some small part in keeping the country going.

But it’s just medical-speak for: “I really don’t have a clue why you have high blood pressure, but if I told you that, you’d probably regard me as an idiot and not take the antihypertensive drugs I’m prescribing.”

Essential hypertension is just one of the terms the doctor hides behind. Another is ‘idiopathic pulmonary fibrosis’ to explain the progressive lung disease. The word doing the heavy lifting here is ‘idiopathic.’ Whenever your doctor mentions it, he’s actually saying: “I’m sorry, I haven’t a clue.” There’s also idiopathic granulomatous hepatitis and idiopathic intracranial hypertension, additional examples of this medical shrug of the shoulders.

Then there’s ‘cryptogenic stroke.’ This is medical-speak that’s used to describe an ischemic stroke – or a blocked artery in the brain – when the doctor doesn’t know why it’s happened to you (or anyone else, for that matter).

When you have persistent tingling in your hands or feet, or you suffer occasional tremors, or headaches, or sudden blurred vision, your doctor will probably diagnose ‘functional neurological disorder.’ It sounds important (you almost feel like you should wear a black tie), but it’s just the doctor’s way of admitting that they have no idea why you’re suffering from these symptoms.

Then there are the ‘psychological problems’ that doctors call those mysterious issues that don’t have a known cause, because there probably isn’t one, since it’s all in your head, so get a grip.

Depending on the doctor’s Paleolithic influences, these can include general tiredness, depression, chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), irritable bowel syndrome (IBS) and fibromyalgia, or general pain around the body.

Strangely, Gulf War syndrome appears on the list. Surely, all the doctor has to do is ask the patient if he or she fought in the Gulf War, and after getting a positive response, they lean back and say contentedly: “Well, there you are then.” But perhaps I’m just being a little naive.

There’s even ‘medically unexplained physical symptoms,’ which sounds like having your cake and eating it. “I’m sorry, you are suffering from ‘medically unexplained physical symptoms.'” “Oh no, what’s caused that?” the worried patient responds. “You’re not paying attention, are you?” responds the doctor.

If you’re feeling a little stiffness in your back, you have ‘stiff-person syndrome.’ Why? Nobody knows. In fact, they don’t have a clue.

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