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IBS, huh? What is it actually?
Aside from all the other reasons to despise American health care (mostly involving predatory insurance companies; privatized health care; inadequate care for women, gender nonconforming, Black, fat, disabled, and other marginalized populations; abuse of medical professionals by schools, hospitals, and senior professionals), I am once again reminded to be enraged at the number of patients given a "diagnosis" of IBS (which for practical purposes means, "Something's wrong with your gut. Damned if I know what!") when they have specific, diagnosable, treatable pathologies.
SIBO. Bile reflux. Reduced FGF19. Gall stones. Biliary atresia. Pancreatitis. Exocrine pancreatic insufficiency. Crohn’s disease. Ulcerative colitis. Celiac disease or gluten sensitivity. Food allergy. Endometriosis.
You can look up symptoms and find all these causes online. But the doctor has fifteen minutes to hear you out, try to remember anything from their training that rings a bell, then throw up their hands and say, "Sounds like IBS. Take an antidiarrheal, eat more fiber, and lose weight (because the insurance company mandates that we tell you to, or because I'm an asshole). Next patient!"
Most of this stuff is treatable with surgery, medications, or even particular strains of probiotics. Yet people are unnecessarily living with life-altering symptoms because an awful lot of us don't have access to medical care meeting even a basic standard of quality.
Things that can go felch a dysenteric tortoise before expiring in a conflagration: Capitalism, puritanical esteem for suffering, discrimination, the HMO Act, and Citizens United. (Also Richard Nixon, if we can briefly resurrect him for this purpose.)
SIBO. Bile reflux. Reduced FGF19. Gall stones. Biliary atresia. Pancreatitis. Exocrine pancreatic insufficiency. Crohn’s disease. Ulcerative colitis. Celiac disease or gluten sensitivity. Food allergy. Endometriosis.
You can look up symptoms and find all these causes online. But the doctor has fifteen minutes to hear you out, try to remember anything from their training that rings a bell, then throw up their hands and say, "Sounds like IBS. Take an antidiarrheal, eat more fiber, and lose weight (because the insurance company mandates that we tell you to, or because I'm an asshole). Next patient!"
Most of this stuff is treatable with surgery, medications, or even particular strains of probiotics. Yet people are unnecessarily living with life-altering symptoms because an awful lot of us don't have access to medical care meeting even a basic standard of quality.
Things that can go felch a dysenteric tortoise before expiring in a conflagration: Capitalism, puritanical esteem for suffering, discrimination, the HMO Act, and Citizens United. (Also Richard Nixon, if we can briefly resurrect him for this purpose.)
rambling on diagnoses
We ascribe to physicians an exalted status as the-knowers-of-the-body, and this has drawbacks for everyone involved. That sounds a bit more 'woo' than I mean -- my feet are still grounded in science here and I'm not suggesting some sort of priesthood-of-all-believers equivalent for medicine. But I think "what is going on with your body" really has to be a collaborative process to work well, even if one side of that process knows a lot more science than the other. It shouldn't be 100% top-down. And if my intuition is right and we tend to reify diagnoses a bit too much, in a sort of category error, well, I think that probably plays into this dynamic. It's striking that it's easy to add a diagnosis to a medical record but very difficult to remove one. Nobody wants to be the one to contravene a doctor -- as though in practice a diagnosis can't be wrong. But if that's so, how can we understand it to be right?
I think about my work as a statistician -- in a consulting relationship, I can only work well when it's collaborative. I need to ask the right questions, to stay quiet when it's not my turn to talk, to communicate in a way that the other party doesn't shut down, to model willingness to be wrong. I think the similarities and differences with clinical relationships are illustrative. They too need to build trust and know when to shut up and all that good stuff, but they are saddled with a power dynamic that I can see getting in the way, an expectation that they are the ones with the final say, and that the word of the doctor is written in ink. Should any of this really be written in ink? There was a time before the diagnoses we know were discovered, and there may be some that we will outlive.
"All models are wrong, but some are useful" is the most famous saying in my field (to the point of being sort of trite, I guess). What would medicine look like if we applied that frame to understanding the body?
Re: rambling on diagnoses
I'm pretty sure that Siderea had a post on exactly this topic. (Which is to say, there is something reliably interesting and insightful written on the topic.) It's bedtime here on the coast, so I won't be searching for it just now. Let me know if you're interested, and cannot easily find it.