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Diagnosis of disease
One would imagine that the diagnosis of disease is a fairly exact science, and if a doctor attaches a label to your symptoms and signs then that doctor should be pretty sure about what he is talking about. But as many of you have discovered, a great deal of medicine is based on guesswork, investigations that are often difficult to interpret and much confusion around the doctor’s ability to understand what you are even trying to say.
At what point for example is your blood pressure really hypertension which requires treatment. Many people come into my office with symptoms of hypothyroidism, but their blood test is normal; and when a doctor calls you pre-diabetic, what does that mean? If the PSA is high, does this mean prostate cancer? And if your hormone levels are low, are you menopausal and do you need HRT? The truth around all these questions is that there is a much larger grey area that your doctor would like to admit. In general the doctor has no time to discuss the complexity of the problem, so tends to oversimplify it and send for more investigations or prescribe drugs when the investigations or drugs are not really necessary.
The medical profession has tried to make it easy for doctors by creating guidelines that can be followed. These guidelines have cut-off points, rather than showing large grey areas (which is usually much closer to the truth). Blood pressure, cholesterol, hormone levels, blood glucose levels just to name a few criteria used by doctors to diagnose disease are merely arbitrary points along a continuum from perfect health to disease. Most people with high blood pressure, even when very high, don’t even have symptoms and may only develop ill health 20 years down the line.
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China is one of the few countries to have successfully integrated its traditional medicine with Western medicine, up to the level of modern hospitals. JEANNE VIALL accompanied a group of South African doctors on a trip to China to visit hospitals and learn more about traditional Chinese medicine.
A toddler lies on her stomach, a doctor vigorously massages her legs while her mother talks to her. The Department of Massage and Habilitation treats lower leg abnormalities. In paediatric out-patients, a nurse in starched cap tapes a patch containing herbs on a baby’s chest, and then her feet. She has a bronchial condition which has become chronic. The nurse explains to the mother how to use the remaining herbal paste at home.
A few floors up, young intern doctors gather to study MRIs on the surgical floor, discussing treatment which may include surgery, post-operative acupuncture, herbal medicine and pharmaceutical drugs.
This is the Guilin Hospital of Traditional Chinese Medicine, the headquarters of a complex that includes another hospital and two community health centres. Guilin is a small city in southern China, located on the Li River, with a population of around 1,34 million.
(see comment at end from Dr Brom on the trip)
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Conversations - A Forum for the Changing Health Paradigm
When a group of open-minded and creative individuals with an interest in frontier medicine comes together for four days to explore the possibility that we are right now in a paradigm shift in the way we view the medical model, something unique arises.
Conversations - A Forum for the Changing Health Paradigm is a journal of such a meeting, held in April 2010. Participants were asked to submit a paper after the four-day meeting, and these form the greater part of this document.
Medical science as practised today has become over-reliant on drugs and invasive techniques to treat disease, creating a dependency on these drugs without a great deal of improvement in health. Instead we see an increase in chronic disease.
The Forum's aim was to explore the paradigm shift now taking place and how this impacts on the way medicine is practised. Clearly there is a need to move not only towards a patient-centred medicine but also a health-promoting medicine, with an emphasis on lifestyle management and ways to support health rather than treat disease.
This document will hopefully contribute to conversations on the shifting paradigm, not only in medical science but, increasingly, in all areas of human endeavour. Come join the debate.
To read the document, click here
Our intention was for Forum to be the forerunner of many more conversations.
We hope to convene other such events to track and stimulate the debate around the emerging shift to a new medical paradigm that is more holistic, integrative and inclusive, patient-centred and empowering, transformative and supportive to a healthy environment and a healthy body.
If you are interested in joining this conversation please write to info@creatinghealth.co.za.
© If you would like to reproduce anything from this document, please contact us for permission at info@creatinghealth.co.za.
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As one gets older and the memory begins to fade a bit and words become difficult to find, the fear of dementia may well raise its head.
As they age, most people will notice a decline in cognitive abilities that generally coincides with other declining functions and evidence of ageing.  These are not generally regarded as diseases, but rather as normal age-related physiological changes. For some older people, however, the decline goes beyond what is considered ’normal’ and becomes relentlessly progressive, robbing the person of memory, intellect and eventually even the ability to recognise spouse or children. Even maintenance of basic personal hygiene becomes a problem and speech becomes badly impaired.
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INTEGRATIVE MEDICINE AND GENERAL PRACTICE |
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IS GENERAL PRACTICE HOLISTIC ENOUGH?
Integrative medicine is not alternative medicine or complementary medicine. It has developed within the ranks of conventional doctors and has been hailed as a paradigm shift in medicine. I will explore this paradigm shift and why it is important, especially in the general practice setting(1).
An editorial in the BMJ suggested that Integrative medicine may restore ‘the soul’ back into medicine, its focus being on health and healing rather than on disease and treatment (2).
The South African Society of Integrative Medicine (SASIM) has defined Integrative Medicine in the following way:
“Integrative medicine encompasses a viewpoint which recognizes the complex holistic nature of the physical-energetic-informational system of each individual and the uniqueness of that system. In this approach the practitioner and the sick individual form a team working towards an integrated protocol of management best suited for that person. Supporting health is a priority, using least invasive and more natural approaches. Treating disease symptomatically may be indicated, but always with the full knowledge of the sick individual.”
There is a great deal in this definition that points to a departure from the present approach of general practice, which has tended to follow the more narrow and radical approach of the medical specialist who is clearly intent on making a diagnosis and treating the disease as an entity separate from the whole body or person (3.4).
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