How to Find the Zebra Among all the Horses…
A Framework for Reasoning in Healthcare when it comes to “Abnormal” medical symptoms and lab Test findings
Do you suffer from “weird” symptoms? No-one seems to find what it could be?
Have you been given a summary label like “depression“, “anxiety“, “irritable bowel”, “fatigue“, “functional…”, “fibromyalgia”, “chronic …syndrome”, or something like it?
Here is the process that I use with my clients to get to the root causes of their symptoms and drill down to how to best help them address their individual situation, illness or disease and help them to truly start living their best life, full of energy, passion and purpose.
This also can help you if you are a healthcare provider (or if you would like to better communicate with your own healthcare provider).
The Current State of Healthcare
Many doctors, despite having good intentions, do not have the time – and sometimes the knowledge or experience needed –
- to take a good history (this alone can take more than two hours in complex cases),
- do additional research (and there is no limit to available resources nowadays) and then
- explain their findings to their patients or clients in a way that they can understand but is not so simple that they can’t make a truly informed decision of their own.
Medical Schools, at least in North America, overwhelmingly focus on using so-called “conventional methods” to “cure” diseases, like pharmaceuticals and surgery.
Medical Students are taught: “If you see hoofprints, think horses, not zebras”.
Which means: Common things are common, and rare diseases are just that. Most doctors rarely see truly rare diseases (pun intended)
“Conventional” Medicine can be immensely helpful and effective for acute (sudden) or very serious illnesses and there have been many advances to help manage chronic illnesses better and prolong life.
I don’t want to take away from these successes. On the contrary, I fully embrace most of these advances of medicine. They have made our lives easier and often better.
Who wants to live in a time without anesthesia (to put you to sleep during surgery), without good pain relief (if you have a broken arm), without antibiotics (to cure serious infections), without public health to improve living conditions and hygiene, and even without vaccines (to prevent plagues like tetanus, polio, and other serious illnesses to maim or kill us en masse)?
I just invite you to study the history of medicine for many examples of suffering that have been removed from our life by the progress of medicine.
Surgery over 500 years ago. Not my choice…
We call alternative medicine everything that is not generally accepted (yet) or embraced by “conventional” healthcare and medicine.
But what we call “alternative” in North America is not necessarily “alternative” everywhere else in this world.
Growing up – and being trained as a physician – and naturopath in Germany, hydrotherapy, balneotherapy, massage therapy, herbal medicine (just to name a few) and supplementation have all been part of “conventional” medicine and still are. I used to be able to prescribe to my patients (paid for by the health insurances) St. John’s worth (herbal remedy for depression), N-Acetyl-Cysteine (for cough), ginkgo (for memory support) and S.boulardii (a probiotic yeast, to help prevent C. difficile infections and treat diarrhea), to just list some of the many. Most of them were extremely efficient and had few if any side effects.
Often the argument against it that those “alternative methods” are not scientifically proven, are costly without giving results and are a modern form of quackery “snake oil”… to give suffering individuals false hope.
And there are certainly methods that belong in this latter category (without naming any here).
So, what really is “scientific proof”? This is absolutely not clear, since science is constantly shifting and changing as novel studies come out, some of them obviously skewed to satisfy the funding sources for the grants that enabled doing the research in the first place.
Now you may understand why I say: Follow the money trail, and you will find the truth. (or at least come closer to it)
Some forms of “alternative medicine”, like chiropractic adjustments, acupuncture, massage therapy, certain herbal remedies and nutritional supplements as well as nutritional interventions, exercise therapy and more (to just name a few) have extremely valid and well-done research behind them. Some of it was done many years ago and has been “forgotten” or pushed aside by the sparkling new medicines our pharmaceutical industry constantly develops (and makes billions of profits from each year).
Treating diseases – especially chronic diseases, with “alternative” medicine can be costly for patients and clients (e.g. if it leads to cancer not being diagnosed early or important other processes overlooked that could have been addressed early if found), but if done right, is often less costly (especially if considering all costs – not just for the healthcare system, but also for the quality of life of the patients/clients, the employers and the out-of-pocket expenses for the patients.)
It also can be extremely costly to treat diseases with “conventional” medicine – just consider the high costs of drugs, medical and hospital care, medical mistakes, treating side effects of pharmaceutical drugs and complications of surgery.
In the end it should be up to us, the “consumer” of health care, to decide what we allow others to do with and for us, what substances (food, supplements, air, skincare, medications…) to put in and on our body – and especially, who to trust and whose advice to follow.
What’s Missing in Current Healthcare…
Missing in our modern world is a class of truly well informed practitioners who have enough training and experience to be able to truly evaluate what is going on with an individual, take their time to get to know them, see them growing and developing over time, and has the will and open mind to explore options with their patient, listen to questions and concerns of them, do additional research, and take the time to explain his/her findings with their patient, make sure they understand the full meaning and consequences of possible options and decisions BEFORE patients decide on measures that may have permanent or lasting negative consequences for them.
Traditionally, this has been the family doctor, who was able to truly get to know their patient, visit them in their home, know their family, knew what they were working and ideally lived in the same community as them.
This entire process is called “informed consent” and is ideally already implemented in the medical system.
In practice, it is not done in this manner.
Patients are left to “trust the expert”, follow their advice and be “patient”... They are discouraged to do additional research online (but thankfully still do it) and often not taken seriously by their doctors if they have concerns about recommended therapies and are called “difficult” if they asked to many questions or even dare to oppose the opinion of “the expert”
What You Should NOT Do
Here a few pointers about what not to do (unless it is an immediate life-or-death-situation and acting immediately will save your life):
- jump to serious decision without any time to deliberate
- agree to anything because you feel pressured to do so
- jump to conclusions yourself (e.g., often I have clients come to me who self-diagnosed themselves on “google” by just reading one article). If we have a preconceived opinion, we often just look for confirmation of this opinion and no longer consider other options. (This is called decision bias)
- accept “labels” or “diagnoses” without having explored all options
- accept a prognosis that makes you a victim (e.g., “there is nothing that can be done” or “get used to your new reality” or “this disease will progress no matter what you try”)
- use your time at the doctor to discuss issues unrelated to your health (e.g., the weather or politics)
- say to your doctor at the end of your allotted time: “Oh, and there is just one more issue I need to talk to you about” – Make a plan instead (see next section)
- verbally or physically abuse your doctor or other healthcare provider. If they cannot satisfy your needs, vote with your feet.
- just complain and complain without ever taking action
- start taking massive action – and then stop because it is too much, and you feel overwhelmed. (Talk to me about how to go about change in a better way)
- lie to your doctor to make it look as if you are following his advice (but you don’t)
What You NEED To Do as Patient/Client to get the best Care for Your Health…
1. Trust your own instincts. In the end, it is YOUR life, YOUR health and YOUR pain and suffering you are talking about.
2. Take responsibility for your own actions – and your life.
3. Use your doctor’s appointments wisely to your maximum benefit:
- Write down questions beforehand at home.
- Be honest. Don’t fib. If you didn’t take your medications, tell your doctor (and why you didn’t). If you don’t want to follow certain advice, let him/her know (and what you are planning to do instead)
- Come prepared to an appointment and state at the beginning to your doctor (after saying hi):
- “Today, I want to discuss (one to max. three questions) and I need (one to max. 3 items)”
If a major decision is coming up and you are not fully satisfied with your knowledge and answers you received:
4. Get a Second Opinion or (in extreme cases) change your doctor.
5. Take a second person with you to your doctor’s appointment, if you feel you need emotional support, need someone to hear what you may have overheard, are afraid that you may forget key details or need someone there who has certain information or knowledge that you don’t. That can be a spouse, child, parent, other family member or friend.
6. Remember the Serenity Prayer. Change the things you can change, and accept the ones you can’t…
What We at DocChristine do Differently…
We are Coaches
First, to make it completely clear: We are NOT licensed healthcare providers of any kind. We are coaches. Coaches help you to make your own decisions by helping you to clarify what you want, what you need and helping you to find a way to get what you want and need faster.
We are like a mountain guide. We can help you find the right mountain to climb, the best, fastest or easiest way up the mountain, even show you ways to walk uphill that worked for us and others, but YOU always will have to climb the mountain Yourself.
Every step is yours. Every success is yours. When you are at the top, YOU are there!
We will celebrate with you all the way.
We help you to start living your best life. You do the living!!!
Here is the Healthcare reasoning process developed by Dr. Christine Sauer:
I don’t assume anything until there is no real possibility of all others.
My variation of the classic saying in medical school: “if you see hoofprints, think horses, not zebras” is:
” Yes, most hoof beats you see are from horses, but do not miss the Zebras!”
My experience in clinical practice is:
Common diseases are common (duh! lol) but if you keep rare diseases in your mind and keep considering them in your differential diagnosis (meaning asking: what else could it be?), you will be surprised how often you see those “Zebras”.
This attitude served me well – as a doctor, a consultant, an educator, a coach and a patient and client myself.
It is an attitude of constantly questioning yourself if anything does not 100% fit with the assumption of a “common” diagnosis or if what you have is not sufficient for a reasonable degree of certainty.
I see many misdiagnosed clients that came from practitioners that – in my opinion – didn’t do their due diligence in excluding important “zebras” – that’s why we at DocChristine offer Turn-around-assessments, as well as additional testing and test reviews of any test that has been already done – with the purpose of digging for undiscovered root causes (the “gold & treasure chest” that may solve all your problems…)
Here is the 7-Step process I follow to evaluate my patient’s/client’s Symptoms:
1. What is the most likely/common cause?
2. What else could it be? (and I go really deep with that, it may require research)
3. If I imagine it wasn’t #1, is anything in #2 important to the patient/client in front of me (obviously the answers are different in kids/young adults/seniors and dependent on other illnesses)
4. What specifically is needed to exclude anything identified in #3 as important?
5. Do all of #4, if at all possible, financially and practically.
6. If feasible, (e.g., if the patient is educated and smart enough to understand and appreciate these deliberations), share these possibilities (discovered in #2, #3, #4 and #5) with him/her without scaring them unnecessarily. (a fine line)
7. If # 6 is currently not feasible, I note these possibilities in my chart for future reference. as well as why it is currently not feasible to follow this process.
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