There’s a common saying taught to medical residents who have just been bestowed the power to diagnose and write prescriptions to properly treat a patient. When you hear hoof beats, think horses, not zebras. Translation: rule out the obvious options first, before you consider more technical possibilities.
In his Ted Talks video “What Makes Us Get Sick? Look Upstream,” Dr. Rishi Manchanda explains that asking simple questions can potentially lead to diagnosis and a simple prognosis for patients before heading straight for the prescription pad. His proposed solution is quite simple. Find the cause instead of just treating the symptoms. He provides a specific example to clarify his proposed solution by providing a hypothetical situation of a bunch of kids drowning and many people suggesting different ways of try to rescue all of the kids.
But one rescuer goes beyond the idea of just saving the current drowning kids and seeks out the root of where and why these kids are drowning and tries to stop it to prevent further drowning kids.
When she asks at Dr. Manchanda at her last revisit why previous doctors were not able to diagnose her properly, he explains that many doctors have a tendency to not ask the taboo questions like “where do you live,” because they cannot solve those types of issues.
So doctors, for a minute, let’s delve into the root of a patient’s problem and not just focus on present symptoms. Let’s consider Manchanda’s argument for a minute that “your zip code can affect your genetic code.” He informs his audience and viewers that in today’s present day, “the living and working conditions that we are a part of have more than twice the impact on our health than our genetic code. Living and working conditions also account for more than 60% of preventable death.” Here’s how.
There’s a point that needs to be stated and understood with this message and that is that this issue can happen at home and abroad. To understand how, let’s get to know two people, Veronica and Ali.
Dr. Manchanda’s patient, Veronica, was experiencing chronic headaches and visited the Emergency Room multiple times before she met Dr. Manchanda. The doctor prescribed her pain medication to treat these symptoms every time. When she finally met Dr. Manchanda, it took only question to find out her diagnosis of chronic allergies. Veronica lives in south central Los Angeles, an area that has smog days and also lives in a house with mold. Dr. Manchanda could not do anything for her, but he did refer her to specialists that could help improve the standard of her living situation that was affecting her health. When she asks at Dr. Manchanda at her last revisit why previous doctors were not able to diagnose her properly, he explains that many doctors have a tendency to not ask the taboo questions like “where do you live,” because they cannot solve those types of issues. He refers to it as the “Don’t Ask Don’t Tell” ideology in medicine.
Now let’s meet Ali, an 18-month-old baby with a missing left ventricle and breathing problems. In the article titled, “Syrian Refugees Scramble For Money to Save Sick Babies,” the author describes him to be getting worse when he develops a chest infection because of the amount of time it takes for him to get treated due to lack of funds. Ali and his family are refugees just like the many other patients that are treated at the same hospital he was and came from a war zone.
The author states in the articles that not many patients have gotten their procedures performed on time and have died from it or have had to borrow money from relatives to cover the costs because, “The UN is currently only able to cover 50% of the health needs of Syrian refugees in Lebanon.”
Even in Ali’s situation, we can take Dr. Manchanda’s tactics to seek a solution into consideration. A doctor may not have the means to treat every issue, but referring them to appropriate specialist that can effectively do so, is just as beneficial to the patient.