Backgrounds in medicine


1. How our preconceived opinions and approach and equipment influence our knowledge and consequences (6/2015)

How we investigate our environment and what results we obtain is to a great extent influenced by the medical instruments and methods we use.
For investigating other factors or processes we may lack measuring instruments or methods, and consequently do not know about certain issues or our knowledge is partial. There is a saying: What you don´t know won´t hurt you. I do not even know what I do not know.
In consequence my results and insights may be fairly partial in comparison to the reality.
For example, health professionals talk about symptoms being “subjective” and measurement results being “objective”.
This suggests that complaints and problems of our patients are often not conclusive for us, neither believable, nor understandable.
On the other hand procedures would provide reliable results, from which it is clearly possible to make diagnoses, give answers about the origin of a disease, determine a therapy and make a prognosis and that without doubt they are right.
But should we not take the complaints of our patient more serious, regard them as the real issue which matters for the patient? What prove is there that we measure the right things and the real processes? Maybe there is a difference between complaints felt and what we measure. In that case the objective picture would be a fairly relative point of view.

Conclusion: Depending on our point of view the terms can even mean the one or the opposite.

What are terms as “subjective” and “objective” meaning in that case?
Let us return to the issue of COPD/Asthma.
COPD is often linked with breathlessness – shortness of breath at exertion, under stress, at infections. Waking up in night with breathlessness, breathlessness in rest.
Meanwhile we have found, that breathlessness is caused by a constriction of bronchi. We should be able to measure it. Of course, we can. The measurement of the pulmonary function enables us to check the volume in our thorax which we can breath in and out, the volume which remains in the thorax even after complete expiration and so on. We can measure the resistance of the airways and check how fast we can breathe out. This tells us about the width of bronchi. In Asthma these profiles often vary to a big extent, in chronic bronchitis only a little.
Logic conclusion: We use the measuring of pulmonary function to make a diagnosis and to determine the severity of the asthma or chronic bronchitis. And we recognize that people suffering from asthma may even show normal results in the measurement of pulmonary function in spite of this.
On the other hand we find people suffering from chronic obstructive bronchitis with severe constriction of their bronchi in the test, but they hardly feel this fact. They lead a fairly normal life.
In consequence we have to consider the existence of other facts, which influence the severity of symptoms. These facts we can not check by the pulmonary function test.
How we evaluate now the condition of our patients depends on our philosophy.
If we think of our lung in a very mechanistic way then our lung is like a pair of bellows. Then we use the results from the pulmonary function test and make a diagnosis based on it or rule it out or define how severe it is. In that way the science of the lung has defined the terms of Asthma and COPD for the past two decades. Meanwhile this point of view is slowly changing, but is still very dominant.
There is much to be said for the fact that asthma and chronic bronchitis are not only characterized by the width of the bronchi. In addition there are interfearances like inflammation and dysfunction. These are not measured by the pulmonary function test. Therefore we have to use other testing methods. It seems we partially lack such methods. For people suffering from asthma we have the NO-Test. It measures a special type of inflammation in the mucoid skin in airways. But not every type of inflammation related asthma is detected by this test. With smokers and in COPD the test does not work.
Pneumology seems to be a science, were many facts and processes are still waiting to be discovered.
The methods nowadays available of testing and the consequently obtained results lead to a fairly mechanistic pneumological view of the world. Are the results of pulmonary function test normal the tested person is thought to be healthy. Do we find a constriction we think he is suffering from an obstructive pulmonary disease. Depending on the type of results we call the disease asthma ore COPD or less often another lung disease. Depending on the dimension of the deviation we determine the severity of the disease.