In the ideal world, diagnosis is easy, treatments all effective & my patients all cured

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By Dr Irwin Lim, Rheumatologist

I subscribe to an email from the BMJ called Editor's Choice. Today, Giselle Jones's words inspired this post (http://www.bmj.com/content/347/bmj.f4970).

She wrote:

"In an ideal world, diseases would be easy to diagnose, treatments would be 100% effective and harmless, patients would recover fully, and that would be the end of that."

I often say something similar to patients - If the drug is 100% safe, 100% effective and really cheap, it will be in our water! Of course, these drugs don't exist. So, my job often is to discuss the risk - benefit ratio.

Worried patients emphasise Risk. Worried Doctors emphasis Benefit.

She goes on:

"Unfortunately, the real world doesn’t deliver such simplicity on a plate, and doctors are constantly battling with far more complex variations of the diagnosis, treatment, and recovery cycle. …….. from diseases that can be reliably diagnosed but are impossible to treat to those that are difficult to diagnose and treat, and even those where the diagnosis itself can do more harm than good."

In rheumatology, we deal often with diseases that are difficult to diagnose for all manner of health professionals, and sometimes, also for us rheumatologists.

Sometimes, detective work is needed. Other times, gut feeling and experience makes the difference. We add up symptom 1 to examination finding 2 to test result 3 and try to make it equal diagnosis 4 (or should that be 6).

Sometimes, we can't be certain. I think it's ok to tell patients that. To keep an open mind and to sometimes let the passage of time make things clearer. Sometimes, we just need to trial a treatment and see the result.

What's your experience of this?