There has been a very dangerous diagnosis floating around; the “Diagnosis of Exclusion”. When the means to verify a diagnosis with an objective measurement is absent, a diagnosis of exclusion is often made. Chronic Fatigue, Fibromyalgia, Myalgic-Encephalomyelitis (ME), Amplified Musculoskeletal Pain Syndrome (A.M.P.S.), are a few such examples. As a specific diagnosis cannot be scientifically confirmed, an umbrella term is used for general classification and then the random medication scramble for symptom management begins.
Is your Physician wrong for prescribing medications to help you feel better? Not at all. That said, if you suffer from fatigue, constant pain and depression from living in a home with mold, how can adding a brain altering, chemically addictive prescription medication for depression promote healing and healthy outcomes? It can’t. Could it help you feel better? Yes.
Can the anti-depressant medication make your health worse? Yes, the medication its-self is a toxin. Can the continued exposure to the underlying cause of your symptoms progress into other diseases while you are medicated? Yes. The diagnosis of exclusion is dangerous.
Today it is a changing model, the exploration of heath related concerns. Many people are not accepting a short office visit, a diagnosis that is just a fancy name for how you feel and a drug for symptoms. Many people are asking; “Why do I feel this way and what can I do to address the root of the problem”?
I have a great deal of respect for and positive rapport with our traditional medical delivery team. I have over two hundred patients in my practice who are Medical Doctors, Nurses, Nurse Practitioners, and Physicians Assistants. No one can deliver the quality of acute, emergent care that they do. Unfortunately, certain chronic diseases that have developed over decades often don’t show up on a normal blood panel or screening procedure. When evidence of disease is not present, the root cause of many presenting symptoms can be elusive to the traditional medical construct.
Every day I ask patients who have been pre-diagnosed with a condition, “Is that a Symptom or a Diagnosis”? For example; Fibromyalgia is a combination of symptoms but it has a diagnosis code. So, you can be “Diagnosed” with Fibromyalgia, but it is still just a diagnosis of exclusion as it refers to a series of symptoms. When you receive a “diagnosis” I like to start by asking what it actually means and why you have those specific symptoms.
Is the diagnosis of Fibromyalgia wrong for a patient who suffers with heightened and painful response to pressure that is coupled with debilitating fatigue, sleep disturbance, and joint stiffness? No, sounds like fibromyalgia. But why do these symptoms exist? Fibromyalgia is not a deficiency of pain medications, sleeping pills and depression medications. But those are the common treatments used. Fibromyalgia is a combination of symptoms from a number of imbalances that do not show up on standard blood testing.
Three weeks ago, my 12-year-old daughter did a back flip, landed on her wrist and broke it. “Salter-Harris, Grade Two Fracture of the Distal Radius”. Boom! Slam dunk diagnosis. Back flip, injury, X-ray, Diagnosis. Causation and treatment are clearly outlined, well understood and executed.
You went on vacation with six family members who all ate the seafood and all became violently ill, you get the picture. In opposition to a slam dunk diagnosis:
• Chronic Pain Syndrome is not a shortage of Ibuprofen.
• Migraine is not a deficiency of Beta Blockers or Imitrex.
• Fatigue is not a low level of caffeine in your blood stream.
• Insomnia is not a lack of Tylenol PM.
• Allergies are not present because you need antihistamine.
• Gastric Reflux is not a lack of TUMS or Nexium.
• IBS is not an insufficiency of toxic gut motility drugs.
• Mood Swings are not a deficit of depression medications.
• P.C.O.S. is not your body’s response to low Metformin.
• Eczema is not your skin deficient in topical steroids.
• PMS/PMDD is not the absence of the birth control pill.
This dialogue could continue on and on. These “Diagnoses” are all symptoms of your body communicating with you, letting you know there is an imbalance. Finding the “why” you have these symptoms is imperative to the management of current health issues and fundamental to preventing progression of disease.
The same hormone imbalance that can cause PMS in an 18-year-old, can cause infertility in a 35-year-old and breast cancer in a 53-year-old. If the Birth Control Pill is used for the 18-year-old but the underlying cause of the hormone imbalance was not identified and addressed, disease will continue. This can manifest later as infertility, another “diagnosis” that is a symptom, and later as breast carcinoma. The teenager who identifies and corrects the “why” of her underlying hormone imbalance can avoid future disease if her health is well maintained.
This differentiation between symptom and diagnosis is not designed to discount the medical advice given by your doctor. There are many conditions that require appropriate medical attention. But, if there is a lack of evidence supporting that diagnosis, or you are feeling like there might be another cause, stop and ask, is this a Symptom or a Diagnosis?
If your doctor does not have a good answer to why you feel the way you do, keep looking, digging, researching and observing patterns and trends. Get second opinions, evaluate the possibilities and find a new direction. Often, a Functional Medicine evaluation will help you to find the root cause of the symptom and gain control over the “Illusion of the Diagnosis of Exclusion”.
Dr. Conan Shaw
Functional Medicine
Certified Clinical Nutritionist
