As a physicians assistant I am constantly inspired by patient stories. It’s part of my job and my joy to listen to patients stories. Often there is more to find out when hearing about someone’s day then there is to find out about listening to individual symptoms. This would seem obvious to most, but in the medical field we are taught to diagnose disease based on the description of symptoms and then of course the physical exam. Often though, because of time we are rushed in this process. I would liken it too trying to diagnose a car’s problem while examining it with just the engine running but not taking it out for a ride. I guess in many ways the mechanics computer system has become quite a bit like our modern day CT scanners. The only difference is that we humans (despite what some like to think) do not come off the same assembly line. Thus a symptom, is unique to that person and must be treated in this way. The important difference here is that a car’s operational manual may be all that a person like me may need to repair his car, but people are much more complex. I think this is most evident when we rely on something like the DSM IV (a diagnosis manual for psychiatry) to place people in rigid boxes in an attempt to correctly diagnose and treat a potential psychiatric disorder. Although this was developed as a way to standardize treatment and come to better treatment algorithms for our patients, I am not sure if this has really served that purpose. In fact simply based on the idea of diagnosis bias, a “diagnosis” of ADHD, or Bipolar “disorder”, to name just two, may in fact cause more harm than it does good. Do I think Tom Cruise was right when he said people would be better off taking vitamins? Obviously not since I prescribe antidepressants and have seen at times very good results. But do I believe that every “car” needs a bit more than just a few minutes running idle in the garage? You bet I do. I also believe that medicine and providing great medical care takes a lot more than reading Harrison’s textbook of medicine.

I feel like medicine as a whole is understanding this idea. This is why we see more holistic medicine and integrative medicine clinics popping up all over and becoming more popular. Our current health care debate on the other hand has failed to see this, and just like we do for automobiles we may make insurance mandatory, but I have a feeling it will be little more than collision coverage, which may protect you in an emergency, but unfortunately will leave you stranded on  the side of the road with a clunker, that would still be running if it had just gotten a little tune up when the timing was right. Let us not make healthcare into car care, let us not wait till the emergency check engine light is blinking to pay for necessary preventative treatments and diagnosis studies. Let us make sure that our future generation of cars gets better gas millage, and necessary tune-ups. Or we can be certain we will be paying a lot more trading in cash for all those future clunkers.