Qualitative Medical Mistakes
As I have always explained to my patients and students, the only reason for ordering a diagnostic test is when the result of the test will change what you do.
​
When people see their doctor, they are seeking medical help. This is a very vulnerable state and people for the most part are concerned about whether they are going to live or die.
​
What can they do to reduce their chance of dying and live longer?
​
That mode of thinking, while understandable, is why we are were we are today. We have stopped thinking about being healthy and started negotiating on simply staying alive.
​
Is it any wonder that physicians have fallen into the same mode of thinking? We don't think about reversing heart disease, cancer, high blood pressure, obesity, et cetera. We don't think about health, we think about disease.
​
This mode of thinking opened the doorway for BigPharma and BigFood (BigAg), to encourage us to over indulge on food and drugs. The result has been an ever increasing chronic health problem caused by the consequences of this over indulgence - InflammoThrombotic Immunologic Response (ITIR) Diseases (ITIRD).
​
In response to these health problems, people see their physicians, who then order tests to confirm their diagnosis of what disease the doctor thinks his/her patient might have.
​
A process that will then label the patient for the rest of their life as having that disease.
​
I frequently tell people as a PhD, MD, JD, that PhDs solve problems, MDs treat problems and JDs (attorneys) cause problems. Unfortunately, JDs are not the only ones causing problems.
​
Unfortunately, too many of our diagnostic tests are not actually diagnostic. They are filled with errors, including failure to find a health problem (sensitivity issues) or exclude a problem (specificity issues).
These problems are primarily driven by a lack of understanding. There is almost nothing worse than someone who thinks they know what they are talking about when in fact they don't. "They were taught" but they don't really understand what they were taught. Or they treated someone and the person got better, so it must be what they treated the person with, when it could be the person was going to get better without treatment, or in spite of the treatment.
This approach frequently leads to doctors and health care providers treating patients like experiments, throwing everything they can think of at the patient hoping for a good outcome. This approach is cauldron medicine - you know, eye of newt, wing of bat, or anything else they can conjure up.
​​
For example, too often doctors (MDs, DOs) and other healthcare providers do not understand that simply looking at changes in weight and blood tests do not mean the patient is getting better or worse. This is one of the fundamental flaws in too many dietary studies. Measuring weight and looking at changes in blood tests may give some inference of what is happening at the tissue level - BUT, it is not the same thing.
Blood tests and weight changes are a downstream phenomena and as shown by research I have published, they do NOT show you what is happening at the tissue level.
​
To drive this point home, let me provide you with two specific examples.
​
1) Endocarditis. Infection of the valves or inner wall of the heart can be found both on clinical exam (listening with your stethoscope to the heart of someone with endocarditis) or using ultrasound (called echocardiography when this is used for the heart). While the echocardiogram (echo) can be useful, it is not exquisitely well tuned to detecting subtle changes. Dr. James T. Willerson, director of my fellowship program used to get very upset with residents who would order weekly echo's to determine the progress of patients with endocarditis.
​
2) Pneumonia. Infection of the lungs (pneumo - air or gas) can be followed clinically (listening with your stethoscope to the lungs of someone with pneumonia) or by chest radiograph (X-ray).
​
The chest X-ray lags behind the clinical course of the patient by 48-72 hours (2-3 days). Similarly Computed Tomography (CT) scans of the chest lag behind actual clinical evaluation.
​
We will come back to this problem with infectious diseases in our last heading - COVID.
Many people are either fooled by what they think they see or are told by others.
When I was medical student, I was trained that independent of what anyone else told me they saw on an electrocardiogram (ECG), Chest X-ray, Nuclear Image, CT or any other study, it was our responsibility to go find the study and decide for ourselves what the study showed. Other people could after all, be wrong about what they think they see.
​
In a now famous study, a group of researchers from the Harvard "Visual Attention Lab" asked Board Certified Radiologists to look at a series of Chest CT studies and report anything "abnormal." The "Visual Attention Lab" was able to track the eye movements of the Radiologists, which allowed the researchers to know that the Radiologists were looking directly at the abnormal areas - eliminating this as a reason for failure to report the abnormalities.
​
Of the 24 Board Certified Radiologists, 20 of the 24 (83.3%) missed the abnormalities on the CT images. These abnormalities (images of gorillas) were 48x larger than what a board certified radiologist would be expected to see if they were looking for lung cancer.
Before criticizing the Radiologists, you should know that no one who was untrained (general public) in reading CT scans saw the gorillas.
People see what they expect to see. The following video shows the result of what we now call "selective attention." See how well you do.
In recent years this problem with selective attention and problems with qualitative image interpretation has received increased attention as women with dense breasts (half of all women) have been made aware that the visual (qualitative) results reported by physicians interpreting what they think they see on mammograms can miss cancers.
The problem is now well understood and recognized, resulting in a Federal Law being passed in 2019. This law requires all mammography reports to include a statement alerting women that if they have dense breasts, that the mammogram may miss their cancer.
More information about dense breasts may be found on the following site.
​
https://densebreast-info.org/is-there-a-federal-law.aspx
​​
The world owes a debt of gratitude to Nancy Cappello, PhD, who lost her fight to breast cancer after her cancer was missed by mammography. She died in 2018 actively fighting for legislation to make women aware of the limitations of mammography.
​
As mentioned, as a medical student I was trained not to be fooled by the errors, mistakes or misrepresentations of others.
The pursuit of knowledge and application of my science (physics) to medical science, resulted in both the understanding and development of the ITIRD theory and FMTVDM quantitative diagnostics and theranostics.