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April 21, 2009 | Modern Hygienist Treat the cause, not the symptom A few years ago, I was traveling by air, and stumbled upon an article in the airline’s seatback publication. If memory serves, the article was called “A Western Physician Looks East,” and it detailed the story of Dr. David R. Schlim, an American physician who became weary of the constraints of the U.S. health care system. Looking for a deeper medical and personal experience, he traveled to Nepal, intending to spend a few weeks reassessing his life and goals as a physician. He ended up staying some 15 years, and grew what became the world’s busiest destination travel medical clinic in Kathmandu. Aside from encouraging development of more natural compassion as caregivers, one of the major tenets of his article (and subsequent book, Medicine & Compassion: a Tibetan Lama’s Guidance For Caregivers, with Chokyi Nyima Rinpoche, Wisdom Publications, Boston 2004) was that we’re great at treating symptoms here in the U.S.A. We’re not so great at treating the underlying cause or downstream consequences. Treating the whole patient is something we’ve left to our colleagues in the Eastern Hemisphere. Why is that? And what exactly did he mean by that? He cited a great example, which resonated with me because I had recently undergone a similar experience. Over the course of several months, I had repeatedly developed severe laryngitis on approximately six-week intervals—after going nearly 40 years without a single episode I could recall. Each time I would lose my voice completely. After the sixth occurrence, I felt it was time to have it checked. The doctor asked a few questions and stated matter-of-factly, “you just gave me the textbook definition of reflux laryngitis.” He prescribed Aciphex®, a proton pump inhibitor, intended to treat the reflux. Treating the downstream consequence (laryngitis) would result from treating the reflux. However, failure to look at the upstream cause is a type of “anchoring” error, described by Harvard Medical School’s Dr. Jerome Groupman in his best selling book, How Doctors Think (Mariner Books, New York 2008). Convinced he had found the cause of my problem, my doctor had dropped anchor and prescribed treatment. The reflux itself was only a symptom, not my primary diagnosis. No questions were asked about my personal life, stress level, dietary habits, exercise, or anything else that might help explain the reflux. He simply prescribed a bottle of pills to treat the outcome. Had the physician not been so busy, he may have taken the time to ask the appropriate questions which would have led to a non-medical treatment of my problem. But managed care does not promote the asking of questions. It promotes production, according to a schedule prescribed by someone whose alphabet soup usually includes MBA, not MD or DDS. Since I am a dentist and engineer, I tend to think logically. Understanding that the reflux caused the laryngitis, I examined both the upstream causes and downstream consequences of my reflux and laryngitis. I realized I needed to eat better, work less and exercise more regularly to address the upstream cause (stress) and potential downstream consequence (esophageal cancer). Once I committed to these lifestyle changes (simple enough to prescribe, less simple to comply with), my problem was resolved on its own. Compliance takes supervision. Supervision takes time. We are not rewarded in the present system for taking our time with patients. CONTINUED ON NEXT PAGE
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