Medicine has changed quite significantly since I first started out as a resident. In some ways, for the better… but mostly (and sadly), for the worse. That said, the one thing that has improved in this field is the variety of testing options we now have available.
Obviously, these advances aren’t a substitute for smart clinical practice. But when used properly, they can take diagnostics to a whole new level. And recent research shows just how big of a difference that can make.
This study shows how combining old and new assessment methods can maximize our ability to target disease early. (Something that’s practically unheard of in American medicine.)
For better outcomes, cast a wide net
Let me begin by quoting one of the researchers: “We capitalized on the depth of longitudinal profiling to identify deregulated molecules and pathways associated with the transition from health to disease.”
Once you cut through all the big words, I have to say… that sounds an awful lot like functional medicine to me!
Here’s what I mean: In this study, doctors used standard clinical tests, like complete blood counts and lipid profiles. But they also relied on enhanced testing, such as screens for cardiovascular risk. Not only that, but patients also responded to questions about physical activity, diet, and stress levels—alongside exercise tests and other forms of physiologic assessment.
Well, that sounds like a regular visit to my practice! And the similarities don’t end there.
Study participants also had diabetes risk assessments—covering both insulin resistance and blood sugar dysregulation. Along with enhanced metabolic profiling, which looked at everything from microbiome diversity to inflammation markers and obesity.
Again, sounds like a typical day at the office for me. And wouldn’t you know? This approach yielded some pretty impressive outcomes, in the form of clinically relevant details—whether it was the presence of diabetes or prediabetes, or other life-threatening conditions like heart disease, cancer, blood abnormalities, or infection.
This was among people who didn’t even know they had these conditions. And mixing these different diagnostic modalities—an approach that I, and many other doctors, have been ridiculed about for decades—revealed them very early.
I hate to keep saying “I told you so” but, well… it looks like we were right yet again.
Looking at a patient’s whole picture
There’s more to being a good diagnostician than exhaustive testing, of course.
I was lucky enough to have been able to spend a year in London doing clinical rotations. Yes, London is great for many reasons. But the best part wasn’t being able to go to a world-class museum any time I wanted. (Though that was indeed wonderful.)
It was being able to get up close and personal with the National Health Services (NHS)—England’s publicly funded national healthcare system.
Now, I realize that many Americans simply can’t abide by a single payer system dictated by the government, fearing long waits to get procedures and all of the other horror stories you may have heard. But, while I’m not a big fan of socialized medicine myself, there’s something to be said for making resources available to all.
The great thing about the NHS was that there was a certain level of healthcare that anyone could get. It may not have been the best, and you may have had to wait longer for it. But in that system, everyone got the basics. (And if you wanted more, you simply had to pay for it.)
So as a doctor in training there, the focus was on being resourceful to make sure every patient got what they needed. Ordering a lot of testing was off the table. So you learned how to think critically, and how to listen to a patient in order to get to your diagnosis.
This training taught me to be a very good diagnostician. Simply by paying attention to what a patient is telling me. (And let’s face it—when was the last time a doctor really listened to you?)
As my practice has evolved over the years, I’ve learned that there are a number of health parameters that play a role in illness prevention. So while the scarcity of tests in my early practice made me a better diagnostician, their later bounty led me to really be able to keep patients healthy, and to point them toward different lifestyle decisions they otherwise may not have made.
And this is simply because my training taught me to look at the whole picture where any patient is concerned. As a result, I do more testing and look at more data points than most other physicians would even think to consider. But always with a very clear purpose in mind.
I try to personalize treatment for each and every patient. This means that every patient who walks in my door will get different recommendations based on their specific needs. And this is something I learned from my mentor, Dr. Robert C. Atkins.
It’s something that sets my practice apart from the rest, and what has made me so successful in my work. So while it’s nice to see research validating the approach, it’s nothing new to me.
And yet, you’ll be hard pressed to find anyone else practicing in this manner. (Another reason I encourage you to ask your doctors questions, or to get a second opinion.) So for the sake of patients everywhere, let’s hope this latest study helps to change that.
“Big Data Reveal Actionable Findings to Prevent Disease.” Medscape Medical News, 05/08/2019. (medscape.com/viewarticle/912749)