The "Truth" in Medicine - Maybe the inconvenient Truth


Senior Member
I am starting this thread out of discussion that came up in another thread and I think it would be a helpful topic for others to understand. What I say will likely be controversial, but I hope I present it in a way that makes sense and will help others in their search for the right provider and treatment.

I will first off say that I am a Physical Therapist who has been in Medicine for over 30 years. 18 to 20 years seeing patients in all kinds of settings. Physical Therapy focuses on function. So my viewpoint is just that. I don't pretend to be an expert in Biomolecular and Metabolic Functions, nor am I an expert in Medications or Surgical interventions. I am, however an expert in how those impact the function of the body and what it might mean for others.

So "The Truth" in medicine. I can't help but think of the scene in the movie "A Few Good Men" in which Tom Cruise is cross examining Jack Nicholson and Nicholson says the now famous line "You Can't Handle the Truth". Missed in most quotes of this movie is Tom Cruise's line which led up to this "I want the Truth!" So truthfully (pun intended) most in medicine can't handle or won't even look for what some including myself would promote as "the truth". That being the patient's presentation being the only true "source of truth". Now it is up to me to explain....

Most in today's modern medicine believe that diagnostic tests or research results are the truth. Treatments are then based on this premise. The problem comes about when there is no conclusive diagnostic test results. Or even more troubling is when those diagnostic results cannot be linked to explain the patient's presentation. This was thoroughly and excellently covered in Jennifer Brea's 2016 TED Talk

The reason this is troubling is because in order to practice medicine in all its forms, one must be able to conclusive link and explain the link between diagnostic tests and the patient's presentation. This takes the training, expertise and experience of a medical provider (MD, DO, PA, NP, DC, PT, OT, etc...). That is why these disciplines exist. Otherwise any non-medical provider including the brightest of people (researchers, statisticians and biological science PhDs) could just do it themselves.

Unfortunately many in medicine have forsaken this responsibility in order to pursue the much simpler route of just referencing the diagnostic tests or a research article. A "true" medical provider does not take their role and responsibility that lightly. They log all of their training/ examination skills, all of the research, all of their understanding of the human body and if they are really good all of the expertise of other medical providers and use it to treat the "presenting problem" of the patient. Which is the "only truth" that matters.

This is the definition of practicing Evidence Based Medicine (EBM). And frankly in my opinion true EBM is the only hope for treatment of diseases like ME/CFS.

The other thing that treating "the truth" does is that it keeps the medical provider humble. There is always more to learn and experience in working with patients. Maybe small nuances that research cannot account for that lead to more effective treatment. Maybe just really connecting with a patient to add valuable reinforcement that a provider believes what the patient is telling them. It changes the dynamic of the relationship which then in turns changes both the patient and the provider for the better.

I know there are many who will say, well don't we need to have molecular or metabolic biological science prove that ME/CFS is a real disease? Don't we need research to solve this issue? Isn't the solution in the "science"? I would answer that as a qualified yes, and that those are secondary issues to making a real and lasting impact on the individual patient or person that a provider sees. That can only be done by addressing "the truth".

This is a very philosophical post I know, but hopefully practical as well. Not sure how many comments or responses there will be, but I felt compelled to share this. It is not something I came up with on my own. It is the collective thoughts of may medical providers and patients (many smarter and wiser than me) I have had the privilege to learn from over the years.