You are waiting on a cold table in a beige painted room. You are sick and in pain, but, at this moment, you are alert like a wolf with its paw in a trap. The door opens and a person in a white coat enters. At first you can’t see their face because they are washed out by the flood of fluorescent light behind them. As soon as you can see, you desperately search their features for any sign of emotion. You hope beyond hope that they will bear benevolent news. At this moment, the wizard in the white coat has all of the authority in the room. They are the one who can bestow upon you a diagnosis.
In medicine, we are eager to label what is wrong with a person. Lately I have wondered how helpful this really is. I have too often seen diagnostic labels become a hex that colors the person’s view of themselves and their potential. I can’t count how many times I have heard a person say “I can’t sleep well because I have fibromyalgia” or “I can’t follow through with my exercises because I have ADHD” or “My spine will always hurt because I have a bulging disc.” The person has taken the diagnostic label and turned it into a permanent part of their identity. It is what they have now, they can’t change or grow out of it. Was this the intent of the provider who granted them the diagnosis? I’m not sure, but if our ultimate goal as providers is to facilitate healing, then I advocate for seriously considering how much our words matter.
Ultimately, a diagnosis is limited because it does not relate the person’s story. Imagine going to your favorite book store and browsing by genre. You find a book in the science fiction section and start reading. This particular book has elements of science fiction, but it reads so much like a fantasy novel that you feel misled by how it was categorized. You read on and there are parts that could be classified as horror and some seriously sexy sections. You wonder what criteria these crazy people used to organize the place.
A diagnosis is limited in the same way. Chronic pain is a genre, but it doesn’t provide direction because all of the people parceled into that category have a different story. Some people with chronic pain could easily have been found in the autoimmune disease section. Others had an acute injury that didn’t heal well while some had no tissue injury but have a highly sensitive nervous system.
Also, what is missing in the diagnostic label is the backstory. What are the environmental, lifestyle, epigenetic, and social factors that formed the vehicle that drove the person to here? Without understanding these, the provider can only aspire to suppress symptoms. The root cause lies in all the gritty details of the person’s life.
Getting a diagnosis isn’t all bad. A diagnosis can affirm that something more sinister or scary is not occurring. It can also assist people in finding appropriate care. However, I would advocate that both clinicians and patients need to assume some responsibilities to improve outcomes.
Clinicians need to use labels more sparingly and they don’t need to be more specific than they accurately can be. For example, a clinician does not have to say bursitis when they could say hip pain. Additionally, clinicians need to take the time to understand the whole story of the patient. Then they can explain the diagnosis in the context of the individual patient. Also, the diagnosis should be immediately followed up with more information regarding potential for healing. This will help patients understand that labels are not a specific default of them, but really a description of a moment in time that encompasses the complex interaction of them with their environment and their lifestyle and history.
Patients also need to assume more responsibility. Patients need to become more interested in healing and progress than in labels. The goal should be to drop labels as soon as you get one, not to hang onto them like a pet. Patients need to understand the limitations of a diagnosis with assistance from their provider. They need to assume as much responsibility as possible in their journey to recovery.
And, above all, everyone – patients, clinicians, all of us – need to believe that healing is possible. Healing is not possible without belief. Thankfully, belief is contagious. Try to pass it on.
