Don’t buy the ‘label’, don’t believe the ‘number’ !

“If you label me, you negate me !”  — Søren Kierkegaard

Vineet is a 38 year old gentleman who visits me regularly for a condition called “dilated cardiomyopathy”. A normal heart pumps about 55 to 60 % of blood contained in it with every heart beat. In other words, normal “ejection fraction” is 55 to 60 %. Vineet’s EF was only 15 % as judged on a 2D Echo exam.

With medications and encouragement to gradually increase physical activity over the year, he is better and symptom- free with his usual activities.

After about a year of treatment, at one such consultation, his wife wanted to ask two questions which had been bothering her since a year. One: will his ejection fraction remain 15 % for ever? And more important, two : Can the family take him on a holiday, say, a hill station ?

I said, of course the EF can improve , and yes he can definitely go on a holiday with care about exerting himself etc.  Before I could ask why she was asking these questions now, she said :

Our first consultant said, EF will never improve, there is no medicine for this and that he should be always confined to the house.

We doctors often are overzealous inn believing and conveying textbook statistics to patients, we forget that what may be true for a thin majority of patients with a typical disease, doesn’t  hold true for ALL patients, that the beauty of medicine and life in general lies in all its variability and unpredictability.

Patients are handed over reports which mention a number, say EF of 15%, or a coronary narrowing of 90 % or that your knee joint is severely worn etc. Studies have shown that the condition of the patient deteriorates after hearing such numbers and labels, such is the power of words from a doctor. However, many patients live for decades with a 90 % blockage in a coronary artery and many patients carry on without pain in the knees despite the x-ray findings.

By suggesting not to believe in the numbers, my purpose is to convey that numbers and labels do not automatically decide the future. True, they are accurate, they make the correct diagnosis, but not necessarily the prognosis. They are useful for the physician to plan treatment and guide therapy, but not to sit on judgment and pronounce the final verdict.

Those patients who have the tenacity and wisdom to not buy completely into the labels and numbers but believe in a force of nature beyond themselves and the healing properties of their own bodies, do well despite all apparent odds.

Listen to the wise words of Sir William Osler uttered as back as 1892 :

“If it were not for the great variability among individuals, medicine might as well have been a science, and not an art” !

NB : By the way, the latest Echo of Vineet shows he has now an EF of 30 %  !! And he recently made a wonderful trip abroad with his family !!