Road Testing Diagnosis
We believe diagnosis is not helpful for patients. Absurdly - it makes no investigation of the cause – and has no strategy for healing. But let’s put diagnosis to the test. Let’s compare it to a common sense approach - and decide which method actually solves the problem.
The Cracked Road Bridge Problem
Engineers are scientists who apply practical problem solving every day. Say engineer Frank Jackson is called in to assess, repair and possibly restore an unsafe road bridge where cracks have appeared in the bitumen road surface.
Medical diagnose-then-treat approach:
Engineer Jackson would focus on the symptoms – the cracks in the bitumen. Then he would prescribe treatment to address the symptoms – say, weekly applications of fresh bitumen to the road cracks as they re-open and become deeper. However because the underlying cause has not been addressed the bridge continues to fail – and is at risk of collapse.
If Jackson had never seen this problem before he might name it ‘bitumen crack disease’. He may even publish a scientific paper on it and eventually be hailed for his contribution to engineering by having the syndrome named after him, Jackson’s bitumenosis.
Common sense (scientific) search-for-the-cause approach:
Engineer Jackson observes carefully, looking beyond the obvious fissures in the bitumen - and searches for possible causes. After a thorough and detailed examination of the design documents, speaking with the engineers and conducting his own testing - eventually he finds and investigates some hairline cracks in one of the supporting girders. With further testing he discovers this particular girder has been made with the wrong steel.
Over the course of a three week project he has the faulty girder replaced with a new steel beam. He then arranges independent stress testing in situ. Finally, satisfied the repairs are sturdy - he arranges to have the road surface resealed with fresh bitumen. He has found the cause of the problem, rebuilt and restored it - thereby solving the issue for the long term.
The Ailing Racehorse Problem
A horse is a herbivore (eats only plant materials) – you can tell by looking at its teeth. But if a naive owner tried to fortify a racehorse’s diet by adding milk powder and ground up beefsteak – in the hope she would gallop faster - the horse would become extremely ill and may even die. This would be slow poisoning for the horse.
Most of us know intrinsically that horses don’t have the physiological equipment to digest cows’ milk or meat. So let’s put diagnosis to the test.
Medical diagnose-then-treat approach:
A veterinary doctor is called in and works hard to give a diagnosis, focussing on the horse’s symptoms. But a firm diagnosis cannot be given. Perhaps – out of frustration he would dub the condition ‘equine idiopathic gastritis’ (horse stomach inflammation of unknown cause). If a bacterial infection were present – that would be blamed – and antibiotics would be prescribed. But if the horse’s diet is never examined she would continue to suffer. The sickness would be progressive and she would likely endure subsequent infections and repeated antibiotics treatments. Her racing career would be over and she would be retired early.
At some stage on that same diet she would suffer organ damage - putting her life at risk.
Common sense (scientific) search-for-the-cause approach:
As the horse has suddenly become ill – the vet checks her all over for any injury, or festering sore – and tests for possible insect or parasite activity. Finding nothing he then tries to question the owner about the horse’s feed - but he is out of town.
The vet focuses on the horse’s diet, believing she may have been poisoned. Analysis of her feed and stomach contents soon identifies the problem. He provides new food for the horse - and leaves instructions for the owner on how to feed her appropriately. He reports the case to the local animal protection authority for follow-up. A week later the vet returns and finds the horse is much better.
