Excuse Me Miss, Your Diagnosis is Showing

A millennium ago, when I attended chiropractic college at what is now Southern California University of the Health Sciences, I had a professor I’ll never forget. Dr. Ahmed wore a long white lab coat and paced in front of his podium, admonishing us to pay attention. What if we missed only one class, one day in our lives, and that was the day he lectured on diagnosing appendicitis? A life might be lost. He had been a medical doctor in Egypt, but after immigrating to the United States, he could not easily get a medical license, so he chose to teach us instead. He related how in Egypt there was little access to diagnostic testing, so much of the diagnosis was made by questioning and looking at the actual patient. A yellow eye indicated liver problems, a pale eyelid could be anemia, a red toe meant gout. We chiropractic students benefited by his wisdom and clinical experience.

Today, I still trust the techniques Dr. Ahmed taught us (and by the way, I never missed his class). Today, I am a better doctor than twenty years ago. Something happens when experience and skill combine with observation, intuition and compassion. If I am sitting across from a pale and exhausted-looking young lady, I would just as soon look at the inside of her lower eyelid and hand her a bottle of iron tonic as send her for lab tests. I’d rather spend time asking her about her life than reading a fax from the lab. She’s probably anemic, but more than that, she’s somebody’s mother and somebody’s wife, and she’s somebody I am not going to let fall through the cracks if I can help it.

In these times, people have to be selective about how they spend their healthcare dollars. Diagnostic testing like x-ray, MRI, bone density scans, and blood tests can be very valuable when used at the right time for the right reason. We can order these tests for our patients and do so regularly. However, at times, they may not be relevant. Sometimes, your diagnosis is already showing when you walk through the door.