Not What, but Why!

© 2003-2010 Dale H. Peterson, M.D.

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See also Fibromyalgia and Fibromyalgia Syndrome; Myofaschial Pain Syndrome

I set out to write an article for this month’s issue about fibromyalgia, a condition characterized by painful spots in muscles throughout the body. I am being asked about the condition with increasing frequency. It is clear that unless the tide changes soon nearly everyone will either be afflicted or know a friend or relative who is experiencing the characteristic symptoms.

As I was in the process of researching and writing the article, however, I realized that unless I first explained a fundamental principle of wellness any attempt to address what is currently called fibromyalgia would fall short of providing hope and direction to those seeking meaningful answers about their condition. It is critical that not only those suffering from fibromyalgia, but anyone who has been given a medical diagnosis understand that the only question that really matters is not what, but why.

June is the month in which I must renew my license to practice medicine. As I was writing the check I paused to consider what I was purchasing beyond the small card I carry in my wallet declaring that I have been licensed to practice medicine in the State of Oklahoma.

Few people understand what actually constitutes and defines the practice of medicine. I suspect that most physicians would have difficulty succinctly explaining what sets them apart from other providers of what is generally called “health care”. The definition of what constitutes the practice of medicine is really quite simple and straightforward. It can be expressed in just two words: diagnosis and treatment.

Whether I, or anyone else, are or are not practicing medicine is often simply a matter of semantics. For example, imagine that you have been working outside on a hot summer day. You feel tired, somewhat dizzy, and your skin is hot and dry.

If I tell you that are suffering from heat exhaustion and advise you to drink water and replace body salts I am practicing medicine because I have made a diagnosis and recommended an appropriate treatment. If, on the other hand, I tell you that using a sports drink to replace electrolytes and drinking plenty of water supports the body’s ability to stay healthy while working in hot conditions I am simply giving advice. I have not made a diagnosis nor have I recommended treatment for an illness.

Doctors define health challenges in diagnostic terms, which determine the recommended course of treatment. It is believed that when a name, a “diagnosis” is identified for a recurring cluster of symptoms, a course of treatment may be found that will address all of them simultaneously. For example, when excessive thirst, excessive urination, weight loss, blurred vision, poor wound healing and an elevated blood sugar level are found in combination, the individual is said to have diabetes. Treatments for diabetes can then be instituted, which may include dietary changes, activity, and drugs such as insulin.

When I wrote my check to the Oklahoma Board of Medical Licensure and Supervision I was granted the privilege of continuing to diagnose illnesses and prescribe treatments for them. I can legally tell someone, “You have fibromyalgia,” or “You have diabetes, “ and I can say, “I recommend that you treat your illness in this way.”

Ironically, the act of making a diagnosis is one of the biggest obstacles to recovery in our society today. A diagnosis is nothing more that a name someone has chosen to apply to a set of symptoms, physical findings, or laboratory results, yet, in many if not most cases, it is viewed as an end in itself.

The following statement by the National Fibromyalgia Research Association is a perfect example of this: “Over 6 million Americans, 90% of them women in the prime of their life, suffer from fibromyalgia syndrome and sometimes struggle for years before being correctly diagnosed . . . Pain and severe fatigue may keep fibromyalgia sufferers from their chosen profession and unable to perform common daily tasks. Fibromyalgia pain continues throughout a person’s lifetime.”

As I understand their statement, they view diagnosis as an end instead of a beginning. People suffer for years before being correctly diagnosed, then continue to suffer for the rest of their life. What, then, is the benefit of being diagnosed as having fibromyalgia? Simply that it is true that misery loves company. There is comfort in knowing that other people are experiencing the same symptoms, that one is not lazy or crazy or both.

While helpful in directing the treatment of symptoms, diagnoses can often obscure the cause of those symptoms and in so doing delay or prevent true healing. Symptoms are the body’s signals that something is wrong, like the warning lights on an automobile’s instrument panel.

Suppose you are driving down the highway when the oil light suddenly comes on. You would have at least three choices. You could continue to drive while the light continued to alert you of an impending problem. You could pull over at the side of the road, get a pair of pliers out of your tool box, identify the wire leading to the light, clip it, and drive on without having to see the annoying light. Finally you could pull over, call a tow truck, and have the car taken in to a repair facility where the problem that caused the oil light to come on could be identified and corrected.

Treating symptoms is much like clipping the wire leading to the oil warning light. Prescribing a drug that relieves the symptom removes the offending signal, but does nothing to identify and correct the underlying problem. As Wier Mitchel, M.D. has so wisely stated, “Medicine is only palliative, for back of disease lies the cause, and this cause no drug can reach.”

Our society is not oriented toward wellness; we are fixated on sickness. Physicians and patients alike have been conditioned to ask, “What is wrong?” or “What is the diagnosis?” as if attaching a name to the symptoms being manifested somehow makes them acceptable.

One of the challenges I face the first time someone comes to consult with me concerning their illness is breaking through the artificial barrier of the diagnosis they have been given by other physicians or the self-diagnosis they have made from reading articles or doing research on the Internet.

When I consult with an individual I am not interested in “what” they have, but “why” the body is sending the signals they are receiving. I want to know the specific symptoms they are experiencing, not the name someone chose to call them.

I believe that the diagnosis is largely irrelevant when the goal is restoring health to the individual. A diagnosis should never be an end; it should be a beginning. Wellness is never achieved by asking “what”; wellness is advanced only by asking “why”, by seeking to identify the root cause of the symptom or symptoms.

This is particularly true when dealing with diagnoses like fibromyalgia and chronic fatigue, symptom complexes that have multiple etiologies and no uniformly successful treatment. When the diagnosis of fibromyalgia is viewed as an end, a life of endless pain and suffering is the result. When the symptoms of muscular pain and tenderness are viewed as a beginning there is the possibility that a cause of the symptoms will be identified, which, when addressed and corrected will allow the sufferer to return to health and vitality.

Consultation with a physician knowledgeable in diagnosis and treatment of disease should be obtained and the use of any protocol should be discussed in the context of a complete management plan.

The opinions expressed are those of Dr. Peterson and have not been evaluated by the FDA or any other third party. They do not necessarily reflect the recommendations of any supplier of nutritional supplements.

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