You are viewing a single comment's thread from:
RE: Time to Throw Away the Diagnostic Criteria for Systemic Lupus?
I think diagnosis is the most difficult part of medicine. My father is a doctor, he describes surgeons as basically needing the same skill set as a carpenter. Obviously with a lot more responsibility.
I think the ideal approach to diagnosis might be something like checklists identifying possible cases, then one or more experts looking at the likely cases in more depth. I guess resources and money are the limiting factors
I've been looking into the different specific aspects of the immune system that cause inflammation in hard-to-diagnose autoimmune diseases. I'm no doctor but have been affected by peculiar autoimmune diseases (both me and family members) so this is more than an academic exercise. For something like lupus (or what is called lupus), which is a creature of many personalities, I think forgetting a label might be helpful. Different manifestations of the disease show activity by different antagonists. Autoimmune pancreatitis, for example, shows IgG4 activity. I'm just beginning to look at this and of course know nothing, but in the case of IgG4, for example, corticosteroids are very effective. Forget about calling it lupus. Just give the steroids. What I'm trying to say here is we don't need a holistic label to treat a syndrome nobody understands. Even with the label, it's hit or miss whether one medication will work or not. Address the specific antagonist and suppress the specific symptom. Whatever the answer is, six years for a diagnosis is a catastrophic medical failure. The profession just has to offer patients more than that, or admit that they are failing.
I think some professionals like to use checklists as a way to avoid taking responsibility, legal or otherwise. stepping outside of the standard way of doing things means they might have to take responsibility if something goes wrong. Of course good doctors don't do this, but I've been to a couple of bad doctors who seem to operate in this way
You're right. I don't blame the doctors. I blame the ACR. There shouldn't be a checklist if it ties a practitioner to a narrow field of options. There's a standard of care doctors have to observe, legally and ethically. The ACR makes that standard impossible for many patients and doctors. I don't understand why they stick to the checklist if it's useless. Maybe they don't want to admit their ignorance.
Let's hope you and I never see one of those bad doctors again :)