Ok. Fair warning. I am about to vent. As in seriously go off. Proceed at your own risk.
At least two or three times per week I meet a patient who is new to my office because for years or months she has been complaining of the same thing over and over and feels she really has not gotten any help from her doctor. She has been told that despite her symptoms, all of her tests are normal therefore she is fine.
Don’t get me wrong, as a business owner, I would love to capitalize on this epidemic. However, as a proud physician, I am so disappointed in some of my colleagues that I feel I must object.
Nowhere is this situation more prevalent than in the arena of thyroid disease.
Here is a hypothetical but very plausible scenario:
A woman in her mid 40s has had months of fatigue, weight gain and depression (ok, it could totally be me but realize I am barely in my 40s) . She makes an appointment with her physician, waits patiently for that visit to come around and then lays her heart and soul out to the doctor. He is patient and attentive. He nods at all the right times and places a reassuring hand on her shoulder. He does a thorough exam and…. (here it comes) orders “blood work to rule everything out.” The lovely lady leaves feeling hopeful that now she will finally feel better. Why did she wait so long to call?
A few days later, a chipper nurse calls from the doctor’s office to enthusiastically report that “everything is normal!” “But” whispers the patient, “what now? I still don’t feel good.”
[insert long awkward silence here]
Suddenly that once sympathetic doctor is “too busy” to take the call—if she is lucky. If she is like most, she is informed that there is nothing wrong with her thyroid and perhaps she ought to consider an antidepressant and a weight loss program.
How is it that the same attentive doctor can have such an about face based on a single solitary blood test??? Why is it that the unflagged, unhighlighted number on the laboratory paper suddenly weighs more than the utterances of the living breathing person he has vowed to help?
To keep this from turning into a physiology lesson, suffice it to say that thyroid lab tests are flawed on many levels. We as doctors don’t order complete panels. Labs have arbitrary and wide normal ranges for those panels. And lastly, people are unique. Much like no two people LOOK exactly the same, no two people feel their best at the EXACT same thyroid level.
While this is a very specific and common example, I think the concept has wide implications.
In all aspects of medicine we need to remember that we treat PEOPLE not TEST RESULTS. There was a time when physicians used their clinical skill and instinct to diagnose and treat. Lab values were virtually nonexistent.
And, guess what? People actually had faith in their doctors.