Why Do Some Patients Not Get better?
For most people, going to the doctor after developing an acute illness or symptom leads to successful diagnosis and treatment. This in most cases results in the patient feeling better and returning to normal – fantastic, just how the system is supposed to work! However, for a large growing percentage of people, the initial doctor’s visit leads to more questions, and visits with more doctors, as the patient has developed a chronic disease, or has symptoms that are not easily explained.
For those who don’t get answers or a good strategy, life becomes naturally very stressful. Rather than suffering from an illness, they become defined by it. They develop limitations that impact their quality of life, and a never-ending sense of “Why me?”.
There are many reasons for why some patients do not get better. This includes the following:
The wrong diagnosis
This is common in irritable bowel syndrome (IBD) for example. Symptoms of IBS overlap with IBD and celiac disease. Furthermore, IBS is defined as GI symptoms with no organic cause. If there is an organic cause and it’s missed, the opportunity to successfully treat the patient is also missed.1 Another major factor increasing the risk for a wrong diagnosis is the realities of the modern healthcare system. Often, doctors have time-restrictions and patient quotas to meet. As a result, they have inadequate time to dig deeply into the patient’s case. This may lead to overt misdiagnosis or a correct diagnosis while missing additional conditions contributing to the patient’s condition. For example, Borrelia might be diagnosed correctly after a tick bite, but a co-infection like babesia is missed, which means the patient never gets well and still suffers with infection symptoms.
Poor lifestyle
Our lifestyle plays an important role in our overall health. In fact, most of the chronic diseases that people die of are driven by lifestyle. This includes vascular disease, type 2 diabetes, some cancers, and neurodegenerative disease like Alzheimers. Coupling a healthy lifestyle with appropriate supplementation and where necessary, medication, is the cornerstone of functional medicine. Lifestyle factors known to play a role in preventing chronic disease include diet, physical activity, sleep, stress management, not smoking, and generating many strong social connections.2 The reality is, while lifestyle plays a big role in our health, it also requires more work than simply taking a medication or sitting for a procedure/treatment, and of course we all want a quick fix!
Self-sabotage
Self-sabotage is another reason why a patient may not get better. This is commonly driven by a patient being unaware of behavioural factors that may perpetuate their disease. For example, people with insomnia do not know that things like light exposure, meal timing, exercise, routines and what they do before bed may disrupt their sleep. And while sleep medications do make one unconscious, this is not the same thing as sleep. Another example includes not consistently following through on lifestyle recommendations. This may be due to difficulty in breaking old habits, social pressures from friends and family or lack of support – it is tough to change if your partner is not interested in health and self-development, exercise or nutrition.
Inappropriate dosing of medication
Medications play an important role in helping doctors reduce patient symptoms. However, in addition to finding the right medication, getting the right dose for the patient is also important. In a study of people with heart rhythm problems taking anticoagulants, 23% were prescribed an inappropriate dose. Of these people, 78% were taking too little, while 22% were taking too much.3 Taking too little may fail to fully treat the disease, while taking too much may exacerbate existing symptoms or create new symptoms due to side effects. On the patient side, taking extra medication to speed up recovery, forgetting to take scheduled doses, or stopping once you feel better rather than taking the full course also impedes recovery.
Lack of more detailed functional tests
A comprehensive blood panel does a good job of looking at the disease state of the body by taking a global look at organ systems. For many, this is enough. However, in others, it’s not. These people often hear, “Your tests are all normal, we can’t find anything wrong with you”. The use of more detailed functional tests based on the patient’s symptoms and the involved organ system(s) can help physicians get to the bottom of the problem. Unfortunately, widespread use of these functional tests is not common. A good example is when cortisol and thyroid blood tests come back as normal. However, the action of cortisol and thyroid hormones and how the body and brain functionally regulates them can really be measured in much better detail via saliva and urine. Often subtle but significant dysfunctions do not always show up on a spot check of the blood – yes, this rules of disease, but tells us little about function.
Environmental factors
Many people are unaware of how common environmental exposures make their conditions worse. Endocrine disruptors like BPA in plastics can exacerbate sex hormone-related problems such as infertility or PCOS.4 Poor indoor air quality due to mold or dust can worsen lung conditions or provoke inflammatory conditions.5 A person’s work environment may also contribute to their condition, particularly if they work in manufacturing buildings with the use of various chemicals. In addition to looking at the patient, addressing environmental factors that promote illness is useful in the treatment of disease.
It’s important to consider all these factors when treating a patient. By thoroughly addressing them, this helps a physician successfully treat their patient, and prevents them from falling through the cracks.
If you would like to learn more about why some patients do not get better, we will be discussing all things related to this topic in our upcoming free webinar on May 11th 2022. The webinar is a collaboration with Food Pharmacy and we are privileged to have Lina Nertby Aurell hosting the webinar. To read more about the webinar and to sign up, click here.
This article was originally published as a guest editor post at foodpharmacy.se
By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm.
Published: 21/04/2022
References
1. https://pubmed.ncbi.nlm.nih.gov/33189181/
2. https://www.frontiersin.org/articles/10.3389/fmed.2020.585744/full
3. https://www.ahajournals.org/jaha/doi/10.1161/JAHA.119.014108
4. https://pubmed.ncbi.nlm.nih.gov/25813067/
5. https://www.sciencedirect.com/science/article/pii/S2212609016300140
