As doctors, we all embrace the notion that the diagnosis rules. Whether we are first meeting a new patient or seeing a patient on rounds in the hospital, we really strive to know what the diagnosis is. The diagnosis “leads the way” mentality has been passed down to us from our mentors and teachers who taught us that establishing the proper diagnosis is critical to providing timely and comprehensive medical care. With the correct diagnosis, we are able to accurately write for the prescription medicines we need to help each patient.
And so it goes that we tend to “get to know” our patients by the way we connect the patient’s diagnoses to the medicines they take. This diagnosis-focused way of thinking has both merits and disadvantages. As I write this, I reflect on the notion that I am seeing more and more patients who have been labeled having a diagnosis without any regard to re-evaluating that diagnosis itself. The down side of the labeling we do is that we do not usually go back and change the status of that diagnosis.
For example, once we tell a patient they have diabetes or heart disease or even depression, we tend to manage their medicines more than we help manage the patient. We regularly ask them if they are taking their medicine and we order lab work periodically to check on their status. But our goals are not generally aligned with an exit strategy for that diagnosis. Once we attach that diagnosis label, it is there for life.
As a result, we tend to shy away from thinking about helping the patient come off the medicine we prescribe. We are all familiar with this notion — patients come back for a check-up and we ask them what medicines do they need refilled, not do they really, truly need this medicine? Or is there a way for them to manage or even get past this diagnosis so they don’t need this medicine?
Since we do not give much thought to patients moving past their specific diagnoses, we generally don’t even think about them coming off their medicines either. Unfortunately, I think this sums up nearly every prescription refill that is written — it becomes a life-long sentence, a mandate. Patients are told by their doctors, "You NEED this medicine," and "Without this medicine, your health will falter."
Certainly there is a time and place for prescription medicine. I write prescriptions for my patients nearly every day. But I think it is time we start being honest with ourselves: prescription medicines are by no means meant to define our health like they do now.
Prescription medicines are certainly wonderful tools when used appropriately. But the reality is, no medicine defines any patient’s health.
Diagnoses are valuable as they allow us to enter into a discussion with our patients about outcomes and statistics and probabilities: now that you have diabetes, it is more important than ever to see how your cholesterol is doing. But having this discussion with the patient should also include a discussion about how to exit the diagnosis as well.
Medicines (nutritional supplements included) are meant to help bridge patients to a better place. Yes, a comprehensive multivitamin and fish oil and a handful of other supplements are great to take every day, but supplements are bridges as well — to get patients to the place where they can thrive without needing any medicine or any supplement.
Unfortunately, diagnoses and the prescription medicines being written are treated as if they are meant forever.
So the next time you are writing a prescription medicine, take a second to pause and think about how you are going to get your patient OFF the medicine and through this diagnosis to a better place. Because ultimately I think our roles as doctors is to do just that — help bridge our patients to a place where we can cross off the diagnosis, not keep adding new ones.
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