Doctoring Knowledge

It’s all connected…

…and this is the crux of the practice of medicine.

I just had a Eureka moment while talking on the phone with a patient. We were discussing how to manage her increasingly frequent episodes of atrial fibrillation. She was also dealing with two other major health problems.

She asked me:

Are these things connected?

In other words, was the increase in episodes related to her other problems?

Yes. Yes.

This is what I’ve been trying to tell anyone who will listen.

In the human body, it’s all connected.

Some might say I spend my days treating heart rhythm disorders. That’s not accurate. I am treating people who have heart rhythm disorders. That person I am seeing may have kidney problems, cancer, arthritis, depression, sleep disorder, a recent surgery or any host of other issues. What’s more, that person has his or her own goals for care.

My job, therefore, isn’t just to suppress the rhythm problem. That’s an easy task. Rather, my job is to make the entire person better. That may mean not treating the rhythm. It may mean educating, empathizing, or helping the person manage other more pressing problems. It surely means seeing the effects our treatments will have on other aspects of human life.

Whenever we treat a disease, any disease, it’s vital that we see the person we are treating.

I repeatedly teach patients that my task is to help them without making them worse. AF is an easy example. The disease gets most scary when doctors get involved. We need to see that fact. We need to teach our patients that fact. There is no free treatment–it all comes with tradeoffs. Anticoagulants reduce stroke risk but increase bleeding risk. AF ablation reduces symptom burden but the procedure comes with a risk for serious complications. Statin drugs reduce the risk of a future heart attack but increase the risk for diabetes. You see the trend.

Cancer is another example. Why is the mammogram story so important? It’s because chemotherapy, surgery and radiation are so hard on the person. When I was in medical school the challenge of treating cancer was to kill just the cancer cells, not the normal cells. That remains the challenge. Surviving cancer often means surviving the treatments doctors prescribe. And that requires an entire person.

Treating disease in the elderly is perhaps the most important time to see the person rather than her diseases.

This precarious balance of connectedness is what makes doctoring so damn special.


8 replies on “It’s all connected…”

Dr. John

A really good physician will not only treat the person, but will also look to treat the causes/triggers of their illness/disease instead of just putting a band aid on it.

Pills, pills and more pills are not always the answer.

“A physician is obligated to consider more than a diseased organ, more than even the whole man—he must view the man in his world” Harvey Cushing

Dr. John, this post should be required reading for all med students. Somewhere between getting accepted into med school and actually treating real live patients, the practitioners of modern medicine seem to morph farther and farther away from focusing on what you describe here: care of the whole person. It’s what Dr. Victor Montori and his Mayo Clinic-based colleagues call Minimally Disruptive Medicine

Your message may come as a revelation to many, in much the same way Chochinov’s landmark palliative care research declared that (wait for it!) patients seem to feel better when their doctors listen to them. It’s such a no-brainer, really – yet clearly needs to be said, over and over. Lather, rinse, repeat.

As a patient, I’m so grateful to you for this important reminder to my health care providers.

As usual, so well said, and so easily forgotten in this day of ‘miracles’ and new and newer magic ‘pills’ and 10 minutes per patient! You are such a refreshing face (voice) in the medical world.

Because of following your blog (recommended by Carolyn Thomas) I just titrated off Flecainide which I’ve been on for over a decade.

I’ve been convinced for several years that my AF is directed connected to “my” Fibromyalgia and the AF episodes that led to the dx and medication/pacemaker probably did not warrant those forms of treatment.

(When I was first treated for heart arrhythmias it was not known that Fibro was a central nervous system disorder. However, two decades later my doctors still don’t acknowledge a possible connection.)

Thank you so much for your easy to read, informative blog which has greatly helped me have a voice in my treatment options.

You just made me like you better. I don’t raise money for Komen for the Cure because I think they are a perfect organization. I raise it because I want any other woman to be diagnosed in stage 1, not stage 3 like I was. Chemo is like killing a fly on your table with a sledge hammer. You may possibly kill the fly, but you will no doubt damage your table.

Surprisingly Harvey Cushing was mentioned above. Today I was started on the road to see if I have Cushing’s Syndrome. It could have been diagnosed 7 years ago if doctors weren’t looking a single organ systems.

Many heart arrythmias are relieved by correcting the very common and overlooked magnesium deficiency.

As doctors we have fragmented our patients into parts. We need to step back and understand the whole patient. They appreciate that when we do.
Bonnie you are so right about magnesium. And it’s not just for arthymias. I got a boy with Tourette’s off all his meds with magnesium, vitamin D, and fish oil. On this he’s an honor student and free of tics. And don’t even bother testing serum magnesium, recall from basic physiology: it’s an intracellular ion. If renal function is normal I just give them magnesium. To bowel tolerance.

Lisa- consider that Cushing’s may exist on a spectrum – we shouldn’t wait until we have full-blown Cushing’s (or Addison’s) to intervene.

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