The most valuable attribute that sets the medical doctor apart from other practitioners is their ability to interpret lab tests.
Let’s face it – there are many practitioners who can offer high quality advice on nutrition, exercise, stress reduction, and other lifestyle factors.
The unique ability of the medical doctor to order relevant labs and put them in context with the patient’s presentation is truly the art of medicine.
The art of medicine
I believe that medicine is more art than science.
The art of a skillful practitioner is to listen to a patient’s story and order a panel of tests to add valuable information to the case.
Sadly, medical care in today’s world has been reduced to an algorithmic approach in an effort to standardize care. Although I understand the merits of standardization, it comes at a cost.
Standardization of medical care into algorithms and reference ranges is designed to categorize patients into those who have disease, and those who do not.
The art of medicine is more elegant than that. An artistic pracitioner is not just searching for a category to place the patient in. They are searching for clues as to why the patient feels the way they do.
Your eyes see what they want to see
I recently went for an executive medical exam at a conventional clinic. As I went through the process, it became clear that the doctor was using an algorithmic approach to my case.
My first clue is that he ordered standardized lab testing before assessing me. The labs he ordered were designed to detect disease in anyone who comes to the clinic.
I was quite certain I had no disease going in to the exam. The doctor confirming this fact was somewhat reassuring. However, it did not address the various problems that I deal with each day.
Common problems that are not diseases often go undetected in algorithmic medicine. They include:
• Sore muscles
The list could go on and on. The point is that these ‘non-specific problems’ affect people’s lives, but do not fit well in the disease model of medicine.
Knowing this, an artistic practitioner will skillfully take a history, and come up with a panel of labs that is uniquely associated with that patient. They will act like a detective to decipher the details of the case. They are not looking for the correct box to place the patient in. Rather, they are looking to understand the patient’s unique being.
The devil is in the details
The artistic practitioner does not rely solely on reference ranges. They will mislead you into thinking that most labs are ‘normal’ and allow you to move past them.
A reference range is based on a random population analysis. The lab will generally include 90% of the values as ‘normal’ and call the top and bottom 5% of values ‘abnormal’.
The problem with relying on these ranges is that the population examined includes average people. I would argue that such people are not the standard to base your health on.
The reality is that many people in the ‘normal range’ are lacking on exercise, eating the standard western diet, and burning the candle at both ends. The inclusion of healthy and unhealthy people in the reference range can bring in a false sense of security to ‘normal values’.
Optimal lab values
There is a growing field of practitioners who utilize optimal lab values in their assessment of patients.
An optimal value is a range of numbers that one would expect in a body that is functioning optimally.
A good example of the difference between the reference range and an optimal value is in triglyceride levels.
Triglycerides represent the body’s storage of fat. This provides insight about a person’s metabolism and propensity to diabetes and heart disease.
The reference range includes any value less than 2.2 mmol/L. The optimal range for a middle-aged male, however, is less than 1.0.
I saw a patient yesterday who had a level of 2.0. A reference range intepreter may have ignored that value. In this case, that level certainly caught my attention, and led to a significant conversation about the health impact of triglycerides.
Optimal value interpretation is a cornerstone of preventive medicine. We strive to treat patient problems BEFORE they reach a disease state.
Beauty is in the eyes of the beholder
The art of a practitioner lies in their ability to put a case together and search for details like a detective.
I suggest that you consider an approach that looks beyond the reference range and focuses on optimal values. You may be surprised by how many clues you might find.
Dr. Rishi Verma, MD
Latest posts by Dr. Rishi Verma, MD (see all)
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