Medical problems differ, but there are common themes in any medical situation. These are the major questions you should ask:
Any abnormal laboratory test requires confirmation.
Some values fluctuate significantly from one sample collection to another. Some laboratory data is meaningful only as a trend line over a period of time. Some radiographic findings have higher probability to be artifacts, especially if a chosen imaging modality is suboptimal for a particular anatomic area or type of tissue.
You have to be certain that the results of all diagnostic tests performed are real and meaningful, and that all diagnostic data are analyzed together and fully.
Additional testing via alternative modalities, or gathering more data points might be needed to confirm the conclusions drawn from test results.
Extensive data shows that a large number of initial diagnoses is incorrect:
- 65% of cases presented to experts for second opinion were originally misdiagnosed or mistreated. This percentage is confirmed by many institutions who analyzed their second opinion case series.
- Of 330 cancer cases reviewed by a major US institution, 90% resulted in “either a new plan or a significant change in prior treatment plan”, and 12% of cases resulted in a change of diagnosis: that is 40 people. No one wants to be one of them: wrong diagnosis inevitably leads to wrong treatment.
- 38% of elective surgery cases were deemed unnecessary when reviewed by specialists; effective conservative treatment was possible.
Even if you are certain that your diagnosis is correct and your treatment is the most optimal, an expert opinion from a world-class physician who sees thousands of cases exactly like yours can provide you with an extra degree of comfort that you are following the correct path to health.
Secondary conditions may also contribute to symptoms and affect probability of experiencing side effects of therapy.
For most diseases, researching prognosis and response to treatment quickly leads to a realization that the gap between “best” and “worst” scenarios is enormous.
Which scenario of disease’s progress applies to you? How different treatment modalities, among several options, may change your prognosis?
“4P Medicine” is already here: Personalized, Predictive, Preventive and Participatory. This certainly presents new options for treatment, but also leads to more tradeoffs and requires thorough understanding of nuances:
Where is this drug approved for use and where it is not? And why?
While in one country the same pharmaceutical company admits illegal marketing practices and pays billions of dollars in compensation to people who died from a particular drug’s side effects, in other countries the same company continues to sell exactly the same or similar drug, and it often pays doctors (directly or indirectly) to prescribe it. That’s a fact.
What are you being treated with?
In a given country or area the most commonly accepted “treatment of choice” for a particular problem might not be the most advanced or most suitable for your particular situation.
If a medical doctor leads an institution that receives hundreds of millions of dollars, pounds or euros from pharmaceutical companies, can this doctor’s advice or policy-making regarding the drugs produced by the same companies be considered unbiased and objective?
It has been shown that doctors who have dealings with sales representatives from pharmaceutical companies “tend to prescribe differently”. Is your recommended treatment free from bias or from the commercial or political conflicts of interest that affect your provider of care?
Are there any clinical trials that could be suitable for your situation? What are the risks and benefits to be enrolled in these trials?
Any pathological process is an interplay between “nature and nurture”. Genetic, environmental, and behavioral factors affect progress of your medical condition.
Often people are told by doctors to stop doing something that “makes your problem worse” or do something to “help you achieve your goal”.
What is the evidence that any advice to change your lifestyle, diet or taking any medicines is prudent and based on science, rather than on marketing or unproven claims?
Is there data from scientific research that has not yet entered wide clinical practice, but which can benefit your situation?
What are the major directions of research for your condition? Are there imminently expected breakthroughs that might affect how your disease is treated?
If you read about a “remarkable discovery” in popular press – is it true? Is it based on solid scientific evidence? Does it make as much impact on clinical practice as the popular press articles suggest?
Is there a global expert in your condition who might enroll you into a small-scale clinical trial or experimental therapy that could benefit you?
It is well known that actor Angelina Jolie had extensive genetic testing after her mother, Marcheline Bertrand, died of ovarian cancer at 56. Her mother’s mother, Lois Bertrand, died of ovarian cancer at 45.
Ms. Jolie’s mother’s sister, Debbie Martin, was diagnosed with late stage breast cancer in 2004 and died from it in 2013, at the age of 61, just two weeks after Ms. Jolie underwent preventive double mastectomy.
Breast cancer and ovarian cancer have overlapping risk factors, as do uterine, prostate and breast cancers.
Actor Pierce Brosnan’s daughter Charlotte died from ovarian cancer at 41 years of age, almost the same age as her mother died from the same disease (at 43).
These are just the most publicized situations because of the movie stars involved and the public’s focus on cancers of female reproductive organs. But they are a vivid illustration that the presence of a given disease in one person might signify an abundance of risk factors for the same or related diseases in other blood relatives of the affected person, often across several generations.
The list of diseases, where a strong genetic component influences their appearance and progress, and understanding of the meaning of such genetic associations, is increasing every day. The tests that identify genetic risk factors become cheaper and more widely available.
Which genetic tests are right for you?
Another example of genetic influence on major health problems is perhaps less known but just as significant.
It is a tendency of brain aneurysms to develop over generations of blood relatives, and even rupture at a similar age across generations.
Rupture of a brain aneurysm has a 50% mortality rate and is the most common first clinical sign that an aneurysm exists.
While decades ago the cause of death might have been simply labeled as “stroke” – a not so rare situation – but ascertaining the exact cause of stroke was often not done, until recently.
It could be that “stroke” was, in fact, acute bleeding into the brain from a ruptured aneurysm. Hence, family history of stroke might have practical significance for the current generation of family members to investigate their health.
All these examples show the value of being diligent to look into many factors that can signal a risk of major health problems in an apparently healthy person.
Be confident in your diagnosis and treatment.