The Undiscovered Art of Medical Diagnosis
Reprint of article published in Conscious Living Web-Site, Sep 2000; also an excerpt from
A CURE IS NOT WELCOME - America's Successful Failing Health System
by Desmond Allen, PhD, MBA, RCP
A PhD in health administration and a credentialed Respiratory Care Practitioner with 35 years experience. The author of A CURE IS NOT WELCOME: America’s Successful Failing Health System, as well as several other articles and books.
A particularly disturbing display of medical incompetence by a seasoned emergency room physician in a well known medical center in the Northeast provided the final motivation for this work. To my embarrassment, after nearly three decades of first hand observation and participation in the blatantly ineffective (sometimes even deadly) clinical arena of allopathic medicine, it was the ignorance and incompetence of these practitioners concerning my own health that finally provoked me to expose this self-serving, clinically deficient, pseudo healthcare system. A system that has run amok with its mostly inappropriate interventional philosophy and the absolutely inept education provided for its master practitioners—the doctors of medicine.
It had been a long day . . . actually a long week, dividing attention between project deadlines, personnel issues and sanity. But it was Friday, mid afternoon and just hours from a three‑day weekend. I had one of those exacting, demanding management jobs in clinical healthcare; barring the highly remote possibility of exposure to some horrible organism it could hardly have been classified as dangerous. Casually and unconsciously I pushed with my left leg to roll my office chair back as I reached for the file drawer. As if in slow motion I felt something in my knee migrate medially and lodge itself in a decidedly awkward position. Even before the pain I instantly understood this was not a good thing.
With expectation, I slowly extended my calf. Intense pain flared immediately. At once I retracted to the original position and the pain subsided. I tried to flex my leg—to draw my calf toward my thigh but again the pain erupted, demanding that I return to the original position. I obeyed dutifully.
Having a fairly good understanding of anatomy I calmly thought through the situation. I considered the physical structure of the knee: joint, patella, tendons, ligaments, muscle, bursa. But I must admit I did not consider the vessels. Perhaps logically or more likely intuitively they did not seem relevant. Pushing, squeezing, probing and pondering—considering for at least thirty seconds—what might have caused this surreal sensation and subsequent reality of pain I concluded that a ligament had slipped out of place. I then massaged and manipulated the joint for at least half an hour, hoping to return the ligament to its proper location. It did not work.
A colleague attempted to extend the leg for me but the pain was unbearable and I had to make him stop. Finally, with great chagrin, I called for help. My employer insisted that I visit the emergency room—our emergency room of course, this being a major medical center in the district. My experience over the next several hours (which I will share shortly), was yet another experience with the medical incompetence of which I am so familiar.
Case Studies in Ignorance
Later that evening I contemplated each time I had sought medical attention throughout my life. Being trained in research and having a considerable amount of medical knowledge and experience, I determined to review the accuracy with which my various medical conditions had been diagnosed and treated. The results were nothing less that startling.
To separate the meaningful from the mundane, I overlooked routine physicals, scheduled follow-ups and minor first-aid type attention. Nor did I include dental problems. The standard by which each physician’s diagnosis/misdiagnosis was evaluated was published medical literature; some were confirmed by other physicians and all confirmed by outcome.
The first significant medical incident I can recall happened when I was fourteen years old. It was a beautiful summer day in San Diego, California. There was an accident that involved a Honda‑50 motorcycle, gasoline and me. I suffered second and third degree burns on my left arm and left leg. Admitted to the local children’s hospital, my arm was placed in bandages that were changed regularly while my leg, which was burned just as badly, was placed in a cast.
After a few days, I was discharged with the cast in place. Back home in northern California, doctor “R” was infuriated at the cast. I can still see the look on his face as he cut the plaster from my leg and found new skin growing into the underlying gauze bandage. He had no choice but to rip the gauze loose, along with my new skin. I can still remember the pain as well. It was smart with an intense tingly, burning sensation. I bare the horrible scar to this day.
Why the attending physician would treat one burn correctly and the other like a broken bone is a mystery to me. Maybe I was a lab experiment for his revolutionary burn treatment. Maybe he had just read and misunderstood some obscure research article. Unfortunately, in those days we did not think of malpractice suits quite so readily. I think in retrospect it might have been an uncontested case.
Years passed before I sought medical attention again. In my mid-twenties, I experienced a skiing accident that caused prolonged stiffness, soreness and swelling in the left knee. It lasted for several weeks but eventually subsided, remaining dormant for many years. Then after sitting immobile for several hours while salmon fishing on the mouth of the beautiful Klammath River on a particularly cool autumn day it flared again. As before considerable soreness, stiffness and swelling ensued. But this time the pain lasted for several months. Every time it seemed to be getting better it would take another turn for the worse. Finally I relented and decided to see a physician.
By now, having studied and worked in healthcare for several years, experience had taught me to view a physician’s ability to correctly diagnose and treat illness with skepticism. Therefore I was compelled first to research the knee myself, to have a good idea of the problem before I visited the physician. I concluded that I had an inflammation of the bursa; likely an onset of bursitis secondary to the old skiing accident.
Dr. “P” performed a thorough examination and suggested that it might be a Baker’s cyst. Having just reviewed every textbook concerning the knee in the hospital’s medical library, I realized the symptoms of a Baker’s cyst and inflamed bursas were similar. However, given my young age and my history (the skiing injury), I highly doubted the Baker’s cyst. But I was encouraged that at least he was thinking along a similar diagnosis; that is, at least it was a diagnosis concerning the bursa. In his uncertainty he sent me to an orthopedic surgeon for a second opinion.
The orthopod stormed into the room, slapped my x‑ray against the light, studied it for at least five seconds, rushed across the room to my knee, pushed and squeezed for a few more seconds then smartly stood back and declared, “You have a condition called plica.”
“What?” I said. I thought to myself, ‘I don’t recall reading anything about this.’
“A ligament,” he answered, “has slipped under the patella. We’ll do arthroscopic surgery with two small incisions: one above and one below your knee,” with this he pointed to the incision sites. “You’ll be as good as new in about five weeks.” Before I could say a word, he turned his heels and was out the door, calling back as he left, “My office will call you for an appointment.”
I was quite disappointed as I left the office. The receptionist called out, “I’ll be calling you soon to set up an appointment.” Even as she spoke I knew I would not be responding to the call.
At work a few days later, limping trough the hospital corridor, doctor “P” happened by. “Did you see doctor ‘S’?” he asked.
“Yeah,” I said with obvious discontent mingled with astonishment, “he thinks it’s plica and wants to do arthroscopic surgery.”
“I thought he might say that,” he smiled coyly. “He just returned from a conference and he’s been real hot on that lately.”
I told Dr. “P” I was not convinced that it was plica and that I was not going to have surgery. He agreed. I also told him that I doubted the Baker’s cyst diagnosis as well and that I was simply going to treat it like bursitis.
In time the flare-up subsided and in the years to come the flare-ups became less frequent and less severe. Now, more than two decades later, it has been many years since I’ve experienced even a mild episode of the “bursitis symptoms.” Who knows what trouble I might have encountered through the years had I followed through with the unnecessary but popular arthroscopic surgery?
The next year I suffered a likely broken nose while playing basketball. Having developed an obvious infection in the nasal septum, after several days the swelling became quite intense and needed immediate attention, for which doctor “P” prescribed an antibiotic. Granted, this was not a situation that required a master of medicine to figure out, but it was a correct diagnosis and treatment. As insignificant as this might sound, I mention it because it is one of the few times that I have been diagnosed and subsequently treated correctly.
Later that same year, after many weeks of reading in what proved to be an unfavorable posture, I developed a very stiff neck that burned with intense pain. Knowing that an MD would only prescribe painkillers or surgery, I elected to see a chiropractor. To my amazement he performed a quick manipulative move and my neck snapped into place. The pain left immediately. I was impressed.
Years later when I experienced similar neck pain, only considerably less intense, I decided to visit a chiropractor again. His techniques were different than the first. He performed a short massage and spent the next twenty‑minutes giving me a sales pitch—inviting me to attend weekly telephone sales meetings that, I ascertained, worked on the pyramid scheme. I left still in pain and quite disappointed. Over the next couple of months, despite my non‑interest, he continued calling to invite me to the sales pyramid meetings. I suspect I should have reported him to his licensing body, but I did not.
Still in pain, I decided to visit another chiropractor. His methods were quite different than either of the others. He was, shall we say, a brutal contortionist. He advised me to spend some time each day lying on my back with a nerf ball placed under my spine to help stretch the tendons and to make them more elastic. It was something he said he did almost daily. I followed his instructions and soon developed a piercing pain that radiated out of my spine, up my shoulder and down my right arm. The pain was such that I had to hold my right arm above my head to experience even the slightest relief.
He had no idea what was wrong, but gave me another massage, twisted me like a pretzel and suggested that I hang from a pull‑up bar several times a day to stretch the muscles.
The next day I attempted to hang as suggested. I could feel the tension in my arm as the weight of my body stretched the muscles. After a minute or so I released, not wanting to overdo it. Later that day I tried it again but this time as I released from the bar there was a horrible “pop!” in my elbow and suddenly my hand and forearm were numb. At once, I knew that my ulna nerve was damaged. ‘This is serious,’ I thought, and instantly I knew my world had changed.
Still in pain and now sporting a dead hand to boot, again I relented and decided to visit an MD. As expected, Dr. “M” prescribed a mild painkiller and a muscle relaxant. During the visit, he noticed that my blood pressure was elevated. This caused him concern. Upon my return visit a few weeks later with my right arm now withering and atrophic from paralysis he was only concerned with my elevated blood pressure. He placed me on the drug of the month and instructed me to come back for follow‑up in a couple of weeks.
There were several follow‑ups in the months to come. My arm continued to wither and the atrophy now involved my right pectoris. Still, other than the pain pills and muscle relaxants, his only concern seemed to be my blood pressure. Exhausted by the entire process, alas I demanded that he address the withering arm. I took my shirt off and showed him my equally withered pectoris. He looked at it, compared it with the left pectoris and with a straight face, actually believing what he was about to say, he asked, “Have you ever heard of kyphoscoliosis?”
“Of course!” I exclaimed, somewhat bewildered, “I know what kyphoscoliosis is.” As I said this I was thinking, ‘But I’m certain you do not!’ I asked, “Are you saying I have kyphoscoliosis?”
“Yes,” he said.
I remained speechless, dumbfounded by his ignorance. ‘What would be the point,’ I thought, ‘of even attempting to discuss this with him?’ Besides, what would I discuss? Would I try to explain my problem again or would I educate him about kyphoscoliosis?—A lateral curvature of the spine with a corresponding hump. My back was as straight as an arrow, always had been, was then, and still is. The absent tell-tale hump, is even a greater mystery; possibly a figment of his imagination or—and more likely—in his ignorance, a central detail he did not realize should be present.
Of course, I never returned. Obviously, he had not listened or paid attention to the progression of my symptoms, nor was he capable of understanding their significance. From the beginning of his treatment regimen I had experienced the undesirable side effects of the blood pressure medicine. Fed up and desperate, I determined to treat myself—both my paralysis and my hypertension.
Unsure as to the expected prognosis for my damaged ulna, I began an aggressive exercise routine. I still had movement in my thumb and was able, ever so slightly, to flex my middle and ring fingers. To flex or extend the other fingers—especially the first finger—was impossible. There was minimal enervation, no strength and virtually no movement. But with my homespun physical therapy, over the next two years I was slowly able to gain flexibility and build strength. Although I still have some numbness in my little finger and the strength in my hand and arm is considerably diminished, I estimate that I have recovered about ninety percent use. Some atrophy is still present and I doubt that I will ever fully recover the lost muscle mass.
As for the blood pressure, after minimal research I decided to deal with it via nutrition. Within two weeks of taking L-Arginine, potassium, magnesium, calcium and garlic supplements, I had completely weaned myself from the medication and my blood pressure was lower than it had been in nearly a year on the prescribed drug. And of course the undesirable side effects had also vanished. Now many years later I continue the nutritional supplements and my blood pressure remains normal.
My next medical condition was mild in comparison. I acquired a mild infection on my right eyelid (perhaps one of the job oriented organisms I mentioned). This time I elected to see a doctor of osteopathy who also practiced some aspects of alternative medicine. He correctly identified the problem and prescribed an antibiotic. Again, I mention this milestone because it is another of the few correct diagnoses and treatments I have received.
Back to the Emergency Room
Now we return to my final and most recent medical experience, the one that actually prompted this work. We take up where we left off with my arrival to the emergency department, my knee locked in place and in severe pain. Beginning with the triage nurse, then the attending nurse and the technicians, I was asked to rehearse the scenario time and again. Somehow I felt no one was really listening; that is, listening critically in an attempt to associate the apparent cause with the present problem. When at last I recounted the scenario to the physician again it seemed to fall on deaf ears. My first clue was immediate. I told him of the sudden movement that seemed to be my ligament dislodging and resting in an undesirable position.
“That was the blood squirting out,” he responded.
What he didn’t know was that logically, or intuitively, I had already ruled out the vessel idea. I thought to myself, ‘He doesn’t really understand what I am telling him.’
As these thoughts swirled in my head he continued with the prognosis, “Before you leave, we’re going to have to straighten that leg. Either you can straighten it, or we can straighten it for you.”
“I hope you know some good manipulative maneuvers,” I pleaded.
“Yeah,” he said, “yank like hell and run.”
My response was terse and no doubt cynical, “You’re not even sure what’s wrong, but you want to straighten it with brute force. If it is straightened, I’ll do it myself.” As I spoke, I had visions of my damaged ulna nerve and subsequent paralysis resultant to following the advice of another medical adviser who didn’t really know what was causing the pain. Although I knew no nerves were involved, there were still muscles and ligaments; neither of which I wanted ripped apart by a violent manipulation performed out of ignorance.
After the initial examination I was sent to the x‑ray department to suffer a series of painful postures. There I learned (once the radiologist had looked at the films) that my knee would likely need to be repaired by an orthopedic surgeon. ‘Oh yeah,’ I thought, ‘I’ve heard that before.’
As I was rolled from the x‑ray department I was very glad to see a friend—who happens to be a physical therapist—standing outside the emergency room. ‘At last,’ I thought, ‘someone who understands the anatomy of the knee.’
I quickly rehearsed the situation again. She listened carefully to every word, examined the knee and within the similar thirty seconds that it had taken me, concluded, “It is possible that your meniscus has become lodged in the joint. This would coincide with the pain and cause the present symptoms.”
I was elated. Here was someone whom I trusted, someone who was extremely knowledgeable about the knee and whose diagnosis agreed with what my body (not to mention my intellect) was telling me. “Will I damage anything if I straighten the leg?” I asked.
“No; but it’s going to hurt and you will need to straighten it.”
Back in the emergency room, the physician returned to report the official findings of the radiologist and to examine the knee again. He said, “I’m concerned that tissue has lodged under the patella.”
“Plica?” I interrupted. This was my second indication that he had no idea what he was talking about.
“Well, yes,” his surprise was clear to everyone present.
“No,” I said, “not again. I have traveled this path before; only with completely different symptoms.” I thought to myself, ‘Is this the only diagnosis for knee trouble that they learn in medical school?’
I expressed my displeasure with his assessment and quickly recounted my knowledge of plica, and my experience with the orthopedic surgeon years earlier.
“Well,” he said, “you still need to straighten the leg.”
Encouraged by the physical therapist's assessment, I decided to comply. Slowly and very carefully, I began extending my leg until the pain commenced. I would hold that position for several seconds, then retracted the leg to ease the pain, rest for a few seconds and repeated the process. Extending a little further with each attempt, I continued this for about forty-five minutes until the leg was nearly straight. Before calling for the physician I tried to manipulate and massage the knee as before—this time specifically hoping to dislodge the meniscus from the joint. It still did not work.
The physician examined my knee again. Now that it was all but straight it presented different prodding options. What he said next was astonishing. It was also the third and most conclusive indicator that he spoke of that which he knew not. Abandoning the plica diagnosis, his next diagnosis was ominous.
Now he explained that the patellar ligament was torn and would require major surgical repair. “We don’t see this injury very often;” he assured me, “but there happens to be another fellow just a few beds away with a similar injury. Only yours is worse. About one in eight of these types of injuries need surgery. Yours is that one.” He even had me feel the torn ligament for myself.
As he spoke, and as I felt my “torn ligament,” I thought, ‘He has no idea what he’s talking about or what he’s doing.’
Then he felt my other knee and said, “Feel this. You have arthritis in this knee and you’ll have to have that looked at as well.”
‘Is this guy for real?’ I thought to myself. Not only have I never had even the slightest symptom of arthritis in that or any other joint, but he has made this diagnosis by simply holding his finger on my completely immobile knee for all of three seconds. There was no x-ray, no blood work, no history, and certainly no symptoms to warrant suspicion, much less a diagnosis.
I remember thinking, ‘This could be an episode on Twilight Zone.’
His plan was to immobilize my injured knee, prescribe painkillers and crutches, and refer me to the orthopedic surgeon. Still experiencing severe pain with even the slightest movement and desperate for relief, I was compelled to comply. To place the knee immobilizer the technician slipped one hand under my knee and the other under my calf. As she gently began to lift my leg the pain intensified immediately and grew, directly proportionate to the number of degrees between it and the gurney. Naturally, sensing the need to be macho in the care of my co-workers, I remained silent and I consciously tried to relax knowing the augmented pain would only last a few seconds. Then just as unexpectedly as the injury had occurred a few hours earlier, the knee instantly popped back into place. A sudden sensation of warmth flooded the knee and the pain vanished immediately. It was as if nothing had ever happened.
“Stop!” I interrupted. “I realize that you have to continue with the immoblizer, but my knee just popped back into place and I want the physician to see this . . . for his own education.”
He was more or less speechless and I would hope embarrassed after his lengthy explanation of the severity of my injury and the need for major surgery. Saving him the embarrassment of another “bursting vessel” explanation, I didn’t tell him about the sensation of warmth I felt as the ligament returned to its home.
Still, as expected, in order to be released from the emergency room (other than against medical advice) I had to follow the plan. I donned the knee immobilizer and the crutches, received the prescription for the painkillers and the orthopedic referral and went home. As soon as I got home I removed the hardware. Of course I never consulted the orthopod. For many months I was careful not to repeat the movement that caused “the meniscus to become lodged in the joint.” I took it easy, allowing time for any possible damaged tissue to heal. As for the arthritis in the other knee, the non‑ symptoms continue.
The Pitiful Diagnostic Percentages
This cursory review of my medical care is most interesting. One of the chiropractors was more interested in soliciting me for an apparent pyramid scheme than addressing my pain. Another actually gave me advice that caused physical damage; and when I foolishly returned to him he followed-up with advice that caused even greater damage. One physician treated a severe burn like a broken bone. A surgeon seemingly diagnosed my knee problem while at a conference, even before my examination. Another physician watched idly for months as my arm muscles grew atrophic right before his eyes. The emergency room physician, who sees multiple bone and joint injures every day, refused to listen to my symptoms and finally determined I had a condition not even remotely related to the actual problem.
Of the eight conditions for which I had sought medical attention, there were sixteen diagnoses, twelve by medical doctors and four by chiropractors. If I am liberal, giving credit for doctor “R’s” correct treatment of my burn once I was discharged from the hospital, and for doctor “M’s” diagnosis of high blood pressure, along with credit for the diagnosis of the two minor infections, there were four correct diagnoses and treatments by the medical doctors—in all, a thirty-three percent accuracy. Of the doctors of chiropractic medicine, there was one in four correct diagnoses and treatments, for a twenty-five percent accuracy.
Some might argue that these experiences merely reflect isolated incidents and cannot be considered an accurate representation of the entire medical profession. I would agree. Unfortunately numerous and more scientific studies make this a moot point. A hundred years of similar pitiful figures compiled by allopathic researchers themselves indict the medical profession’s inability to diagnose accurately. Despite advanced medical technologies several studies show that diagnostic accuracy is no better today than it was a hundred years ago . . . about fifty per cent.,,,,,,
These studies, as well as my experience, strongly support a contention that I have held for many years. It is imperative that each of us take control of our own health. Medical knowledge abounds, readily accessible to everyone. Make use of it. We might not understand everything we read or hear concerning our health or a given medical condition, but as we have seen, and I will further prove, likely neither does your physician. With interest and a little effort we can learn enough to ask the right questions, to be aware of obvious ignorance and to take charge of our own health.
It is imperative that we do not simply place our health and our lives in the hands of a physician without first learning all we can about health and our particular illness. Seek the physician’s advice? If you feel you must. (In all fairness, allopathy has developed a number of procedures for certain extraordinary conditions that have great value.) Get a second or third opinion? Insist upon it once you have decided to seek the first. Trust any of them implicitly? Absolutely not!
Medicine functions on several levels. Some physicians with a natural mechanical ability have a certain intuitive flair and for them medicine is an art. Few, very few, approach medicine like a science. These practitioners make diagnoses only after meticulous processes of elimination and they only prescribe therapies for which there is solid evidence. However, most physicians practice medicine like a religion. Having no intuitive ability for the art and very little understanding of its scientific aspect they diagnose and treat each condition according to tradition—a tradition frequently disturbed, modified by scientific discovery. Thus, it is not without reason that Stuart Berger, MD, warned, “Caution: Doctors May Be Hazardous to Your Health.”
. Jensen Bernard. Ibid. p.ix.
. Kirch Wilhelm and Schafii Christine. Misdiagnosis at a University Hospital in 4 Medical Eras Report on 400 Cases. MEDICINE. 1996;75(1):29-35.
. Harding, T. Swann. Forum. June, 1929, p348.
. Kirch, Ibid.
. Gut A L, Ferreira A L and Montenegro M R. Journal of Nursing. 1993 Jul,8-21;2(13):655-656.
. Tai Dy, El-Bilbeisi H, Tewari S, Mascha E J, Wiedemann H P and Arroliga A C. Chest 2001 Feb;119(2):530-536.
. Kirch, Ibid.
. Berger Stuart M. What your Doctor Didn’t Learn in Medical School. New York, NY: Avon Books; 1988, p 16.
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