Episode 2 – Why your doctor hasn’t fixed you yet.

Hello and welcome to episode 2 of the Cambridge progressive medicine podcast series.

In episode 1 I suggested that if we want to feel better than we currently do we need to take a fresh look at our whole concept of health.

But maybe we are already getting ahead of ourselves.  

If we want to start doing something differently, we first need to recognize and understand what we are currently doing. We need to understand why what we are currently dong isn’t working for us. Otherwise there will be no incentive or drive to make a change, and we will more than likely just carry on doing what we have always done.

If you keep on thinking and doing the same old things you will also carry on feeling the same old way.

In general most of us in western society adopt a concept of health based in western medicine – I guess the clue is in the name!

The model of western medicine is to study the normal anatomy, physiology and biochemistry of humans – essentially to study how the body works, and then look at ways in which it can go wrong – what we call pathology or disease. Once disease is identified western medicine aims to make changes to the anatomy, physiology and biochemistry of the body, with drugs or surgical procedures, to try to restore the body back to its “normal” or healthy state. In this model a symptom (a pain, or unpleasant experience in the body or mind) is seen as an indication of an underlying malfunction in the workings of the body, and treatment is directed at identifying and then rectifying the malfunction.

So, for example, let’s say you have been experiencing some tummy ache, and so you go to see your GP, he or she listens to your story and your symptoms to take a history, maybe lays a hand on your tummy, and then makes a diagnosis; – “There is too much acid building up in the tummy, you have heart burn”, and they prescribe you a medication, omeprazole, which reduces the acid in the tummy, and takes the pain away.

Great! And it is great, and often we can identify problems in the body, and intervene to fix them.

My 15 years of training in medicine has almost exclusively been about learning to detect disease in this way, and then employing scientific, evidence based treatments to rectify them. I have essentially been trained to sell this model of western medicine to the punters – to you, my patients.

And it’s a great success. There have been incredible advances in western medicine. Diseases that would have certainly killed you 100 years ago (even 20 years ago in some cases) are now entirely treatable, and I have no doubt we can expect further advances in the future. We are living longer than ever before. If you were born in 1841 your life expectancy was only 41 years. Billions of people all over the world have been treated by, and benefited from this scientific model of western medicine. Countless lives have been saved.

So what’s the problem? And why do we all still feel so unwell?

In many ways western medicine it is a victim of its own success.

The problem is that western medicine is extremely good at treating a set number of specific conditions; conditions that it has studied extensively and understands. If you are suffering from one if these conditions it will save your life.

And because of this, not unsurprisingly, we have placed a great deal of faith in it.

We expect, even demand, that it should be the solution to all of our problems. If we experience a symptom, a feeling, or a thought that is unpleasant to us, we naturally assume that this is a sign of a malfunction in our bodies. And we look to western medicine to 1. Tell us what is wrong and 2. Give us a pill to fix it. Why wouldn’t we, after all its done for us.

But the truth is there are almost an unlimited number of possible ways the body can go wrong, or produce unpleasant symptoms, and a great number of these, western medicine knows nothing about at all, and has no idea how to treat.

The human body is fantastically complicated; people and their symptoms often don’t fit into a neat little box. There are thousands, even millions of different interactions and processes going on, both physical and mental. Not to mention the impact of individual social, and emotional factors.

Because of this it is often incredibly difficult to know for certain what is causing a particular symptom or collection of symptoms, and the likely benefit or potential harm any intervention will produce. 

Let’s pick up on the example of the tummy ache from before.

Let’s suppose you take the omeprazole, it reduces your acid and your heart burn gets better, then western medicine had done a great job.

But what if you develop an unwanted side effect. The listed side effects of omerprazole are as follows – Abdominal pain; constipation; diarrhoea; dizziness; dry mouth; gastrointestinal disorders; headache; insomnia; nausea; skin reactions; vomiting. And that’s just the ones that are common or very common.  Maybe you feel even worse than you did before you started.

What if you take your omeprazole, your heart burn is better, you get no side effects, but then it interacts with your heart medication and makes it less effective.

What if you take the omeprazole, and you just don’t feel better?

Possibly your acid is reduced, but not enough, because we haven’t addressed the reason it was high in the first place, maybe you are drinking a lot of coffee, or are eating something that is irritating the stomach, maybe you are under a lot of stress, or have a hormone imbalance. If we haven’t changed the underlying cause it’s unlikely that you will get completely better.

Maybe, and this is the big one, maybe, the diagnosis is wrong all together -and you haven’t got high acid levels at all!

I’m going to make a confession, and it’s one that doctors don’t often like to admit.

The truth is it is not that unlikely that some of the time the diagnosis I make in my NHS GP surgery is wrong. Plain and simple. Just wrong.

And I am willing to bet the same is true for all GPs, in fact for every doctor who has ever practiced.

And it’s not because we are negligent. It’s the nature of the beast. It’s simple probability. A doctor generally makes 1 single diagnosis, if he said it was 2 or 3 different things we might lose faith in him – we would think that clearly he doesn’t know what he is talking about – it wouldn’t fit with our western concept of medicine and health.

But there are hundreds, probably thousands of possible diagnosis that could be causing any 1 particular symptom or collection of symptoms. So the chances of getting it right are 1/1000!

Well OK, not 1/1000. Because some things are much more common than others, and some things fit better into a box than others, and I hope that I learnt at least something at medical school.

But even so, an NHS GP has 10 minutes, probably 6, by the time you have walked in from the waiting room and taken your coat off, to consider the interaction of hundreds and thousands of processes. Physical process, mental processes, social and emotional factors, in an unbelievably complex machine, and arrive at the correct diagnosis, and prescribe a treatment that is not only going to cure the problem, but not cause any unwanted side effects.

So do we really expect them to get it right every time?

Is it really reasonable to expect the model of western medicine to be the solution to all of our problems?

So I guess you are thinking – How do I sleep at night?, when I know that many of my diagnosis are not even right! It’s a fair question, and one that I have asked myself on many an uneasy Sunday night.

The reason I can sleep at night is this: It’s because I know that, most of the time, it doesn’t really matter.

Yes, you heard me right, – It just doesn’t matter.

It doesn’t matter because, most of the time, the problem will get better anyway. It will get better if we do nothing at all, and it will get better in spite of any intervention we make.

The reality is that in general the human body is much better at healing itself than doctors are. And a lot of the time it would do it better without our interference.

Not convinced? I like to think of it like this. All the wonders of western medicine, of scientific discovery, of physics, chemistry, engineering and computer science are unable to create anything anywhere near as sophisticated and incredible as a human being. But the body can create another human without any training at all. So, why should we suppose that we know better than the body when it comes to maintenance and repair? Who knows better how to repair my car than the person who manufactured it?

Of course, there are times when the body can’t heal itself, and that is where western medicine comes into its own.

The good news is that western medicine is extremely good at the conditions where the body is in real strife, when its capacity to heal itself has been overwhelmed. Doctors are very good at identifying and treating life-threatening conditions. It makes sense that when learning about diseases scientists have focused on the things that are going to kill us first.

So, your GP will inevitably get a diagnosis wrong from time to time, but if you go to see your GP and you are having a heart attack, or have sepsis from a chest infection, you will get the right diagnosis, and prompt treatment that may well save your life.  

The NHS is an incredible resource and we are fantastically lucky to have it.

I have learnt that in medicine the sicker the patient is, the easier our job is. You would think it would be the other way around, but it isn’t, because a really sick patient is far more likely to be suffering from a condition that doctors understand, and therefore know how to treat. 

And this brings us to the central problem with the model of western medicine. Most people who I see day to day in my NHS GP surgery’s (thankfully) are not having a heart attack. They haven’t got Sepsis.

In fact they haven’t got a condition that fits neatly into a western medicine box. They haven’t got a condition that western medicine understands or knows how to treat.

Instead they have a lack of wellbeing.

I think I’m going to leave it there for today, to give you a chance to think a bit before we move on. 

These podcasts are designed to help you to take control of your own health and wellbeing, and I can understand that after 2 episodes it may seem this is further from your grasp than ever.

Most of us trust in western medicine implicitly, and I’m suggesting that it may not be the full story, and perhaps doesn’t hold the key to good health.

But that isn’t much good to you unless we can replace it with a helpful alternative.

Because of that I think it is pretty important that you don’t stop listening now, as otherwise I may have caused more harm than good.

So, I really hope you will join me for episode 3.