Empiricism in Medicine- A scary thought

And my best friend, my doctor
Won't even say what it is I've got

-Bob Dylan

Probably cos he actually doesn't know what it is that you ve got. Have you ever wondered that a doctor you visit could be wrong or he is not treating your disease but just your symptoms ?. (No I am not talking about the Patch Adam crap about holistic approach ).I would like to draw attention towards something which can be loosely termed as Empiricism. As a surgeon in India, I realised that most of the patients are not definitely diagnosed and treated specifically for that disease but they are "symptomatically palliated" as it is apparently the most cost effective approach. I am guilty of this crime too. In India, doctors are drilled with the philosophy of minimalism, due to obvious lack of resources. Ergo, we treat patients empirically with wide presumptive diagnosis hoping that the thearpy will work, since diagnosis is the most expensive part of the treatment in most of the cases. In this practice of minimalist empiricism, we glaringly miss the gist of the modern medicine i e .. Evidence based approach. I think Its imperative to have a definite diagnosis for the reasons quoted below:

1. Though treatment might not differ much (favourite argument of the empiricist practitioner), But the patient will have knowledge about the natural history of the disease, prognosis and if there s any complication associated with it can be better treated. furthermore its always better to know, afterall we know the insecurity in fear of unknown.

2. Its better for a doctor to know the definite disease so that he can treat it well. Almost all patients in India are either overtreated or undertreated due to this empiricism.

3. We dont generate enough evidence with this sort of practice. But we do develop gut feeling. A doctor with a great gut feelings (probably due to their intelligence and experience) is a good doctor in this scenario but its not scientific.

Diagnosis should be THE MANTRA of new age medicine in India.