Garbage Can Diagnoses… NOT the Cause of Illness!

Garbage Can Diagnoses… NOT the Cause of Illness!

Addressing the Real Causes of Your Poor Health

Paul A. Goldberg MPH, DC, DACBN, DCBCN
Consultant to The Goldberg Tener Clinic
Chronic Disease Reversal

The average physician spends five to ten minutes with a patient… a totally insufficient time to identify and address the causes of a patient’s illness. The usual scenario is that the physician hears the patient’s symptoms, looks for a few outward signs, names symptoms, signs off with a “diagnosis” (primarily for insurance purposes) and moves on to the next person waiting for him. The patient leaves with a drug prescription and/or an alternative type medication to suppress the symptoms the physician named with a “diagnosis.” Patients with chronic disease conditions generally repeat this cycle repeatedly as their disease is “managed” rather than reversed.

Currently there are thousands of different medical diagnoses based on symptoms and signs. Some are particularly convenient for the physician to utilize. Bacterial infections, for example, are likely to be “diagnosed” in pediatric offices where in seventy five percent of the cases the child leaves with an antibiotic prescription.

The scenario of naming a patient’s problems with a diagnosis describing their symptoms but failing to identify causal factors is particularly common with patients having “chronic” health issues.

Good examples of common diagnoses I’ve long referred to as “garbage can diagnoses” include:

These are also known as “diagnoses of exclusion” i.e., the physician, having excluded other possibilities of the patient’s problems, fails to know what the actual issue is and defaults to assigning one of these. The patient believes their problem has been identified. In reality, however, the cause remains unknown, the disease persists and a drug prescription likely to complicate the patients’ issues, waits to be filled at the pharmacy. The following case from our clinic illustrates this all too common scenario. After identifying and addressing the actual causes of her problems, the patient regained her health and is no longer taking drugs to suppress symptoms.

The garbage can diagnoses listed above are common yet there are numerous others assigned in the realm of chronic disease conditions.

Most Rheumatoid Diseases and other Autoimmune “Diagnoses” (one hundred forty of them ) e.g., “rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis do nothing for the patient in identifying causal factors. Rheumatologists assign a name to the patients’ inflammatory issues yet patients frequently have their “diagnosis” changed to another rheumatoid disorder in time. Despite the numerous autoimmune/rheumatoid disease diagnoses, similar drugs e.g., steroids and biologicals are utilized and the patient remains under lifetime medical “management” never experiencing a return to long term health (read The Problems with Prednisone and The Dangers of Biological Drugs).

To address causal factors in chronic disease issues and move away from non-productive diagnoses that fail to produce reliable health, it is critical to understand that:

  • There are cause(s) behind chronic disease conditions e.g., Rheumatoid Arthritis, Chronic Fatigue Syndrome, Inflammatory Bowel Disease, beyond simply listing them as “cause unknown” or “autoimmune.” With the appropriate effort and investigative skills, causes can be identified and addressed to allow health renewal.
  • Since the medical name assigned to a patient’s chronic disease is based on symptoms and signs, “treatment plans” will also be based on symptoms and signs. Little wonder that medically diagnosed “chronic diseases” remain chronic!
  • Patients can have similar symptoms and receive the same medical diagnoses and prescriptions yet have widely varying causes for their health problems. When a person is born there are seventy trillion possible genetic variations that can take place. We are individuals with broad biochemical variations that are further accentuated after we are born by external factors. We should not be herded into diagnostic categories that fail to take into account our biochemical individuality .

What are the major etiological (causal) factors that should be explored with patients having chronic disease conditions?

At a minimum, the following should be addressed during the initial evaluation with the doctor:

  • Family History
  • Patient’s health, social, environmental and occupational history from birth to the present.
  • Analysis of the patient’s lifestyle factors including nutritional status, drug use, alcohol, caffeine, tobacco and recreational drugs. Familial relationships. Occupational satisfaction. Major stressors including familial issues.
  • State of the patient’s digestive efficiency and microbial balance.
  • Toxicological Survey. There are thousands of environmental toxins in the air, water, soil, home, and food, originating from industrial pollutants, volatile chemicals, organophosphates, phthalates, building materials, cosmetics, fertilizers, pesticides and herbicides all increasingly pervasive and contributing to many chronic disease conditions… yet rarely sought out or uncovered. We screen patients through advanced laboratory testing for toxins generated both within the body and externally from the environment. These include toxins such as glyphosate, volatile chemicals, industrial pollutants, organophosphates, styrene, 2,4D, arsenic, lead, mercury, yeast and fungal antigens, bacterial overgrowths and other burdens that create imbalances in the immune, endocrine, nervous and gastrointestinal systems. Rather than label the patient with a chronic disease name, once toxic exposure(s) are identified they can be addressed. This frequently leads to the resolution of chronic health issues that otherwise would simply be suppressed by a lifetime of pharmaceuticals.
  • Specific health goals as stated by the patient.

Identifying and Addressing the Causes of Chronic Illness…What is Required of the Doctor?

  • Time: An hour and a half of the doctor’s complete attention should be allotted to each new patient to obtain a thorough analysis. Written forms can help in the process, but eye to eye communication is essential.
  • Academic Training: The doctor should be skilled in establishing a comfortable rapport and have the appropriate clinical skills to put the pieces together (history, examination and laboratory studies) to establish causal factors (not merely naming a “disease”) resulting in the production of a causal based program for the patient to follow. Course work in clinical epidemiology and being a good health/disease detective is useful in the training of capable practitioners. Patience and good communication skills should be part of the doctor’s persona.
  • Experience: No amount of training can substitute for long term experience in working with a variety of patients over time assuming the doctor has been attentive with his patients.
  • Follow Through: Rather than simply assigning patients a garbage can diagnosis and handing them a canned program based on that designation, the doctor should approach each patient as an individual with individual needs as they progress through the steps to restore their total well-being. The doctor should not be content to suppress symptoms but rather seek to establish reliable long-lasting health for the patient.

What is Required on the Part of the Patient with a Chronic Disease to Return to Good Health?

  • A willingness to be forthright with the doctor in helping him or her thoroughly explore their background and be evaluated through the interview, physical examination and laboratory procedures.
  • Patience and perseverance in implementing the prescribed program understanding that ups and downs in symptoms are to be expected as chronic illness is uprooted from the patient’s body and health is restored.
  • Understanding that they, the patient, must be willing to work hard and be an active participant in their health restoring program.

Reversing chronic disease / restoring good health is much different from assigning a garbage can diagnosis and suppressing symptoms while poor health continues to progress.

Personal attention, a generous amount of time, experience and good training are all required on the part of the doctor to restore the health of the chronically ill patient. For the patient, active involvement, patience and the will to get well are needed. Together, with these attributes, the doctor and patient can go far in restoring health to the legions of chronically ill patients seeking to restore their well-being and return to the joys of healthful living.

Click the following links to see video interviews with our patients illustrating the good outcomes that are possible: Autoimmune / Allergic Disorders, Digestive Disorders, Rheumatoid Disorders, Hormonal / Weight Disorders, Diabetes, Chronic Skin Conditions, Cardiovascular Disease, Chronic Headaches, Thyroid Disorders, Fibromyalgia, Chronic Fatigue.

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