“Why am I really getting this test?” Have you ever found yourself asking that question? I have. Your doctor may explain the reason. Yet, you may not realize that the underlying philosophy of a health care practice may be influencing those determinations. Decisions, and the reasoning itself, can be opinionated. It’s a controversy. Does your Doc practice Functional or Symptom-Based medicine? It might be a big deal to you – more than you realize.
What’s the Difference between
Functional & Symptom-Based?
I will define the philosophical differences in extreme shorthand.
Functional Medicine: Goal to treat patients so that they ‘function’ to the best of their ability, now or in the future.
Symptom-Based Medicine: Goal to treat patients based on reports of complaints or feelings from the person, and observation of symptoms.
Understandably, by the nature of their viewpoint, the action-plan approach can vary greatly. I don’t intend on delving into a detailed explanation of both, but instead offer a short summary comparison.
Functional Medicine (FM) is a newer approach to practice. It’s not Dr. Welby. But the term can be used in other ways. Physical Medicine also uses the word “functional.” When I was in school, the mantra was “treat the cause, not the symptom.” But in the overwhelming majority of those times, they meant treat the cause of a pain, complaint, lack of strength or decreased range-of-motion, etc. Not always. But mostly. Physical medicines (like Physical Therapy and Chiropractic) are not solely restricted to these domains, yet generally treat muscle, bone, joint and neurological based ‘problems.’ This is what I was thinking about when my Family Nurse Practitioner (of a year or so) told me she practices FM. It’s different.
In the FM world, every effort is made to find the underlying status of bodily conditions and how things are ‘functioning.’ FM practitioners employ some of the rarer and more obscure tests, along with the usual ones, to help them determine a patient’s current foundation. It is not uncommon for these professionals to be alternative-minded providers who approach treatment with alternatives as well. Common too are the recommendations of (somewhat) difficult lifestyle changes. So, be prepared.
I have since come to realize that it is now common for Physical Medicine practitioners (especially chiropractors) to take up the FM mantel. As always was the case, aside from acute care (to treat current severe conditions and symptoms), they regularly practice “maintenance” care (to maintain your symptom-free progress) and ‘preventative’ care (avoiding symptoms). However, in addition to this, some are considering the rarer evaluations for external and internal functioning.
Testing is a mainstay of FM, but there are concerns voiced by some of these physicians who suggest that the tests are not always sensitive enough, with lab results frequently (and significantly) lagging behind complaints and symptoms. [We all recognize that story a la ‘Chronic Fatigue Syndrome’ now called SEID – Systemic Exertion Intolerance Disease. That condition remained undiagnosed and sometimes disbelieved for years. SEID is still a difficult disease to diagnosis with various viewpoints on relevant tests and causes, but still many, sometimes-mysterious, symptoms.] The theory of a possible ‘lag’ is sometimes followed with the recommendation to skip the more ‘general’ tests (like TSH for Thyroid) and proceed to the more sophisticated and sensitive testing.
My question is “but what about those without complaints?” Through reading and other sources, I can extrapolate and boil down the expected response from a FM practitioner. Most likely, it would sound like “the goal is to avoid assumed future problems and improve general health.” Tests are objective. Thus, the bottom line is tests rule.
Perhaps considered a more ‘old-fashioned’ approach, it’s bottom line is probably symptoms rule. Aside from their own observations and conservatively recommended lab tests, the SBM provider relies on the patient. What patients say, report and how they feel.
Two of my MD friends occupy this category. He feels the person reigns. His mantra being, “Treat the Symptoms, Not the Test.” She spoke of the worry that FM can lead to “over-testing, over-treatment and unnecessary patient anxiety over test results.” [Of course, as mentioned, the treatment in FM tends not to be pharmaceuticals. Still, it can include expensive supplements and repeated, sometimes equivocal and unclear laboratory findings.]
The SBM practitioner may wait watchfully (“active surveillance”) to determine if the symptoms resolve. They may also hesitate ordering multiple evaluations or blood analyses, which can be viewed as unwarranted. Positive test results (remember that means ‘bad’) can cause stress to the patient (that means us), occasionally unduly. It can be particularly annoying to those without symptoms. But is it a matter of “what you don’t know CAN hurt you?” Maybe. Maybe not. SBM practitioners can be accused of over-testing as well, but generally, their investigation continues only until a cause of a symptom, pain or complaint is found. They tend to avoid what they consider ‘over and above’ necessary.
The debate continues. This post was simply to point out that there IS a debate. You can easily explore more of it online, especially if you read between the lines. Maybe someday a clear answer – meaning a winner in this debate – will be decided. For now, it’s really your decision. As we age, you may wish to think differently than your Doc. You may want to ‘pull out every stop’ for best function available. Or you may wish to listen to your body and react accordingly. It’s our choice. But our provider’s philosophy may be influencing it.
Picture credit: ElisaRiva 2020310_1280 via pixabay