by Marina Danilova
I used to watch House with my son years ago, buying every new season on DVD as soon as it was released. We stopped at Season 5 I think, for a reason I don’t remember (maybe my son grew up and it was not as much fun watching it on my own?). Recommending it to a friend prompted me to go back to the series this spring, and I am glad I did. Apart from the brilliant acting of Hugh Laurie, everything of quality that relates to the field of medicine grips me immediately. So it has become a great entertainment and nice distraction from news media and opinions which have been otherwise hard to avoid.
Plus, I can relate to House’s excitement when it comes to “solving the puzzle”! In spite of some differences I actually find many of the diagnosis essentials to be the same both for his team and us, Chinese Medicine practitioners. Let me share a few thoughts on this here:
1. Symptoms assessment
Any diagnosis starts with symptoms. Both Dr.House and we use what we can see (or what a patient reports) to figure out what we can’t see. Remember House’s white board with the list of symptoms, and every time a new symptom goes on the board or an old one is taken out, there is a new task for his team to reassess the diagnosis? I have learnt to do the same – to not look at symptoms in isolation.
When we build the understanding of physiology (I use Six Conformations), it is useful to contemplate what a given symptom is a sign of. But in clinical practice, when assigning each symptom to a Conformation and then try to put them all together, the outcome of the diagnosis is misleading (common trap, mind you). Instead, we should aim to employ Dr.House’s “white board” approach, and assess as follows: the patient has A, B, C, D and E – why?
House validates his diagnosis with blood tests, MRI’s and biopsies (and by other means only possible in fiction). We have our own tests: looking at the tongue and feeling the pulse being the main ones. But above all, we investigate by asking questions. However, this does not mean that we should ask more. Instead we should ask better, deeper, and always with purpose. When we know what’s important to evaluate, we understand what information will help us get there. Often we don’t need to know about everything going on in the patient’s life and body, but we really need to be 100% clear about the things that matter. That’s why we don’t stop at “yes” or “no”, but keep on investigating “how bad”, “how long”, “when did it start”, “how has it changed”, “what makes it better”, etc.
3. Bouncing ideas
Gregory House has his own diagnostic team, and, when at one point he does not, he uses a janitor to bounce ideas off. We normally work on our own, but every now and then it is helpful to validate our thoughts, brainstorm, or get another perspective. Maintaining a network of like-minded professionals can come in handy. I say “like-minded” because we know Chinese Medicine is not uniform, and just asking any colleague can be of little use. One other thing I find priceless is having a mentor.
Being focused throughout the diagnosis is essential to arrive at an accurate one. However, focusing is not the same as thinking hard. If we concentrate on thinking, we may find ourselves going in circles - churning the same ideas, getting nowhere. Focusing on something other than the problem actually helps us see it differently and come up with original insights. House uses tennis balls as his thinking objects. We might have another method, e.g. focusing attention on Dantian or whatever works for us individually to “quiet the spirit and settle the will”.
5. Knowing our medicine
It is obvious that House and his team have an impressive biomedical knowledge. Imagine going to a hospital where doctors have limited idea of the medicine but know pharmaceutical drugs really well? Sounds ridiculous, yet it is not an uncommon issue in our field. We spend years “diving” into herbs and only “surfing” the foundations. We become experts in herbal medicine yet remain inferior practitioners. This struggle will not be over unless we develop a deep and clear understanding of the very basis of Chinese medicine. It can be summarised as Yin and Yang, and their interplay that unfolds in a circular manner, known as the Taiji principle. May sound simple, but to really know it, to make this knowledge practical, takes serious training.
Even if we may not normally deal with critically ill patients, our responsibility is great - especially if we treat with herbs. A solid approach to the diagnosis makes a whole lot of difference both to how competent we feel as practitioners and, importantly, how effective our help can be. That’s why diagnosis is my favourite thing to master and to teach - and like watching House, it never gets boring.