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Treating Numbers Vs. Treating Symptoms

There are many instances in medicine when a patient’s “numbers” require treatment even if they are feeling perfectly fine.  Some examples of this are:

  • Elevated blood pressure:  Hypertension can often be present with no symptoms at all with the affected person feeling well.  However, over time, this “silent killer” can markedly increase the risk of stroke, heart attack and sudden death.
  • High cholesterol levels:  Once again, most people have no symptoms from having elevated cholesterol levels until something negative occurs such as a heart attack or stroke
  • Low Vitamin D levels:  Vitamin D is important for bone health as well as the immune system.  People with low Vitamin D levels will feel nothing wrong.

On the other hand, there are situations in medicine when the “numbers” are not as important as the clinical symptoms.  Here are some examples:

  • A male with libido, lack of energy and depressive mood has a “normal” serum testosterone level, yet is presenting with classic signs/symptoms of “Low T”.    With the “normal” testosterone level ranging from 264-916, even if this person has a testosterone level in this range, he should still strongly be considered for treatment.
  • A female in her low 40’s presents with a number of menopausal symptoms but yet labs only show minimal changes.  Based on symptoms, HRT (hormone replacement therapy) can still be considered.
  • A patient presents with classic low thyroid symptoms (weight gain, fatigue, dry skin, cold intolerance) and the thyroid lab testing is “normal”, although closer to the lower range of normal than the higher range  Treatment with a low dose of thyroid replacement should be considered.

As a physician, I believe it is important to not simply treat “numbers” but rather, evaluate the entire picture, with the patient’s symptoms being a very important part of this evaluation.  As a patient, it can be quite discouraging and frustrating to go to your doctor with a number of symptoms, have testing done, and be told “everything is normal”.  Clearly, if you are not feeling well, something(s) is amiss.

A final thought:  As “AI” (artificial intelligence) is becoming more and more a prominent concept with growing applications to many different fields, I am hoping that in medicine, the robot evaluating you/your family is not simply looking at “numbers”.  Maybe there is some role still present for the doctor in a white coat.

And for music by the numbers: The Number One song 50 years ago today?  Don’t laugh too hard:  Tony Orlando and Dawn’s ‘Tie A Yellow Ribbon”.

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