Eliminating "doctoring-by-the-numbers?"

Back some 30 years ago (oh my, has it been that long?), our lab diagnosis professor taught us that it was bad doctoring to only look to laboratory results when deciding on the best treatment course for a patient.  He especially cautioned us not to look at total cholesterol levels as they could be misleading, particularly for a patient who presented with high HDL-2 numbers.  That could skew the total cholesterol results, contributing to a false positive, so to speak.  It truly amazed me as to how many patients had lab work done that did not include individual totals of both the "bad" and "good" cholesterol levels.  Even more troubling, we still find that so many patients continue to be prescribed cholesterol lowering medications that are still based on total bad cholesterol levels, alone.

Last evening, I was listening to the results of a report in which a panel of research doctors had decided that it was better to look at a patient's lifestyle and background along with his cholesterol results when determining if pharmaceutical intervention was necessary.  Amazing.  For example, a white male of 50 years who has an LDL level of 170 and an HDL-2 level of 45 has a calculated risk of heart disease of less than 5%, so no medication is recommended.  A black male presenting with the exact same numbers has a calculated risk of nearly 9%, therefore medication is recommended.  So, technically, the doctors are looking at race and gender to determine the need for medication and not just LDL levels.  Even that small change of approach is thought to pose a significant problem for those doctors used to simply looking at  predetermined cholesterol levels as the method of medication necessity.

It is quite possible that there really isn't a one to one direct link between a specific resulting number from a cholesterol test and the onset of heart disease.  These numbers assigned to LDL, VLDL and HDL levels are simply educated "guesses," and certainly not written in stone.
One person's "high" LDL levels may be another person's "normal."  We have found that to be true in cases of body temperature...one of my family members has a "normal" body temperature that is so low that he has a fever when the thermometer reads, "98.6."  He has trouble convincing doctors and nurses of this.

Years ago, the pathologist at the lab where I sent patients to get lab work done always ended his report with the following statement:  "Theses results should be used together with the patient's clinical presentation to determine method and effectiveness of care."  With the explosion of prescription medications for patients simply in response to their lab results, one has to wonder when the medical profession changed its collective mind about how important it is to look at the patient as a whole person and not just as a set of numbers.

Frankly, I think patients have done the same thing.  We've noticed a tremendous difference in patients' attitudes since we first started practice.  Many patients used to be interested in alternative choices for lowering their cholesterol or blood sugar levels.  Now, we find, with precious few exceptions, no patients interested in even discussing the possibilities of alternatives to medications.  I believe we are an over medicated nation and we have ourselves to blame for the unintended consequences that surely will follow.

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