06. Understanding Your Symptoms: The Critical Role of Differential Diagnosis

Hey friends, this one's for both practitioners and patients who've been around the functional medicine world for a while.

Here's the thing. When you've been dealing with chronic symptoms for months or years, it's really easy to fall into patterns. You start assuming every flare-up is the same old story. SIBO acting up again. Mold toxicity. Food sensitivities.

But what if it's not?

I'm talking about the differential diagnostic list, which is just a fancy way of saying: all the possible things that could be causing your symptoms. And here's where it gets tricky for those of us working in the functional medicine world.

We get so focused on the chronic inflammatory stuff, the SIBO, the parasites, the mycotoxins, that sometimes we can overlook the conventional diagnoses. The diverticulitis. The cancer, God forbid. The kidney stones. The things that need attention now.

I'll be honest, this is something I actively remind myself about. When I'm seeing a patient I've worked with for two years, and they come in describing abdominal pain, it's tempting to just pick up where we left off. But if they tell me the pain is different somehow, more intense, or now there's bleeding when there wasn't before, I cannot just chalk that up to hemorrhoids and move on.

Now, if you're a patient, here's what I want you to hear. Pay attention when symptoms vary, even just a little bit. Maybe they're 20% more intense. Maybe they're not triggered by the usual things.

And here's the critical part: don't present it to your practitioner with presumptions already baked in. Don't say, "Oh, my SIBO is flaring up again." Just describe what you're experiencing. Let them go through their checklist.

The differential diagnostic list in functional medicine is way more expansive than in conventional medicine. That's both a gift and a challenge. We're thinking about things other practitioners might miss. But we cannot let that blind us to the conventional stuff.

Being comfortable is not always a good thing. Experience helps us work faster, but complacency can be a real stealth enemy.

That my friends, is definitely the reality of medicine, especially at the intersect of functional and conventional medicine. Worth it, but more work.

In This Episode:

• Why the differential diagnostic list matters for both practitioners and patients
• The risk of getting too comfortable with chronic symptoms
• How to communicate symptoms without presumptions
• Balancing functional and conventional medicine approaches

Key Takeaways:

• When symptoms vary even by 20-30%, pay attention
• Don't attach labels to your symptoms before presenting them
• Practitioners must guard against overlooking conventional diagnoses
• Clear communication protects both patient and practitioner

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Transcript

Welcome And Purpose

Dr. Mark Su 0:09

I'm Dr. Mark Su and welcome to the Functional Medicine Reality Podcast. Join me and our community weekly as we bring you unfiltered health from inflation to longevity. Real stories, real people, real solutions. Experience real life health changes from both patients and practitioners, and learn how to turn cutting-edge information into real results in your own life so you can feel better, live longer, live healthier, and be confident and clear in your healthcare choices. Let's get real and get results. Hey friends, this is a really important topic I have for you today, especially for you if you are a prescribing practitioner, meaning you can write for prescriptions. All right. And that infers to me that you have a certain kind of license, a certain kind of medical license. But it's also really applicable as really deepful insight, meaningful, deep insight for those of us who, as patients who have been around the functional medicine world, you've wrestled with a lot of chronic symptoms for a meaningful length of time and have done a lot of them searching and digging to try to get better. This will be really meaningful to you as well. All right. And you it is as applicable to how you interact with your practitioners, whether current ones or future ones. All right. So here's the topic. The term for today is the differential diagnostic list. All right. Not to get technical, but we're talking about the differential diagnoses that a presenting patient might have for any given singular symptom or multiple symptoms. And the more symptoms a person has, the more complicated and lengthy that differential diagnostic list becomes. Alright, so what is this differential diagnostic list? In in conventional medical training, this is a really important part of what we learn to do in evaluating patients. It is the list of possible diagnoses that might explain the person's condition. So let's keep it really simple today, and let's just say we're talking about abdominal pain. So in conventional medicine, if someone has pain in their what we call left lower quadrant, all right, down below the belly button, the left side, the lower abdomen, that quadrant, okay, just above your left hip, all right. If a patient presents with left lower quadrant abdominal pain, as an adult, let's say someone over 50, 55 even, the first thing that most everyone's going to think about is diverticulitis. Alright. However, when a patient then says it's been going on for three or four months, alright, now suddenly that shifts things. The likelihood of it being diverticulitis drops down the list in my book. I think most of my colleagues would all agree, because the likelihood someone's had diverticulitis for three or four months is pretty stinking slim, all right. So all these factors that we as practitioners, clinicians are asking patients about how long has it been going on? Where is it, where do you feel those symptoms? Is it all day and all night? Is it s associated with eating? Is it associated with exercise? All these different factors, they start to influence our thinking and try it's helping us narrow the differential diagnostic list down to the most, the top two or three most likely causes. Okay. So somebody just says to me, I've had left lower quadriabdominal pain, but they don't tell me anything about how long it's been, how bad it is, and any more detail. The differential diagnostic list is lengthy. Diverticulitis, sure. Again, let's just keep it within a 50, 55-year-old person, okay? Sure. Diverticulitis, sort of some sort of nonspecific colitis, just inflammation of the colon. Could they have some kind of ulcer colitis or Crohn's disease as an inflammatory bowel disease? Could it be muscular, all right? Could they have gotten hit playing sports or something like that? It's a muscoskeletal issue. Could it be that they have a kidney stone? Could they have a UTI or bladder infection? Could they have palone nephritis as a kidney infection? Could it be referred pain from somewhere else, not likely gallbladder on the flip opposite right upper side of the abdomen, but some other referred pain from somewhere else in the abdomen, okay? And so right there, the list can go on even further. Could the person simply just be chronically constipated or meaningfully constipated, right? All kinds of possibilities. But here's the take-home message, okay? If you're a prescriber and you work in the functional medicine world as I do and my colleagues, my close colleagues, it is really easy for us to think about all the various possibilities of abdominal pain, right? Especially in the functional medicine world, we start going into thinking about SIBO and CIFO, food intolerances, food allergies, subclinical, hard to diagnose, less detectable helicobacter pylori, parasites, the mold, mycotoxins, even unusual symptomatology with Lyme disease, especially if there's a bunch of other symptoms going on. The differential diagnostic list is very different and way more expansive than even just the conventional medicine differential diagnostic list, right? And it is really easy for us as prescribers to get, dare I say, caught up in or sucked into the that differential diagnostic list in the functional medicine world. But we gotta remember when it comes to with functional medicine, we're talking largely about chronic inflammatory conditions, all right? And we cannot, as prescribers, overlook the prioritization of those acute problems that can be big and bad, and that can get us really in trouble if we overlook that commonly are in the more conventional medicine world. Okay? First and foremost, if you're a prescribing practitioner with one of those more conventional licenses and all that, state board licenses and all that stuff, you're up a creek. We are up a creek. If we're not thinking about the common diverticulitis issue or cancer, God forbid we overlook cancer, okay? So the the take-home here for us as prescribing practitioners is the following. We gotta remind ourselves and teach ourselves to remember to go through the conventional, common list of differential diagnoses at the same time as, if not sometimes commonly even before we think through the chronic inflammatory sort of functional medicine diagnostic list. Okay, differential diagnostic list. When we know our patients really well, or we've been seeing them regularly, all right, we can have a lot easier, it's a lot easier for us to skip past, if you will, or reassure ourselves that we can rule out those conventional topics because they're describing a an extremely familiar and recurring symptomatology that we are very familiar with. Okay. But even if you're working with a patient that you've known for two years and you've seen them ten times or more in those two years, if they describe symptomatology in the same location or in a similar way to what they've experienced before, but it's somehow different, especially more intense. Like in this case, yeah, they've had abdominal pain for off and on for two years, and you've known it. All right. I've known it. Let me put myself in that shoe. I'm the practitioner and I've known it. It's easy for me to just pick up on where we've left off in all those conversations about all the issues, SIBO and on an organic acid testing, the clostridia and whatever else, okay? But I gotta be attuned to that there's something different about what they're describing here today, and I cannot overlook diverticulitis. And if they are, and I've been working with them for two years, but I knew at the beginning that they've never had a colonoscopy, and now the symptoms are different. Maybe they're having a little bit of bleeding. Yeah, it's easy to chalk it up to hemorrhoids, but God forbid, and it is not in the patient's best service if I just assume that it's internal hemorrhoids or whatever else, we have to do our due diligence and rule out those big bad things. Okay. Now, the so first and foremost, it's it is not in the patient's best service to overlook those topics. And number two, you and I are going to be in bad places of liability, especially as those with more conventional licenses and such, with different kinds of expectations by the public's eye at the very least, and certainly in a court of law, than functional prescribers who are non-functional practitioners who are non-prescribers and who many patients sort of self-select to see because they are outside the conventional box. But generally speaking, they're at less liability risk of a lawsuit. All right. Now, the take-home message for you as patients, for any of us as patients, is when we've wrestled with the same symptoms for a long time or recurring symptoms, okay, it is also really easy on the flip side of the coin for us to be chalking up our symptoms to the same old. All right. Oh, I'm having abdominal pain again. Oh, it's that whole my PCP calls it IBS, but I know it's more about SIBO and I've had some H. pylori at times and whatever the case else case may be, okay? But we have to be attuned to recognizing when the symptoms vary, even just by a little bit. Maybe the symptoms I'm having now aren't triggered by the usual triggers. Maybe it's not the same time of year that I always have those symptoms. Maybe it's 20%, 30% more intensing than it usually is. All right. Maybe in this case with abdominal pain, I have bleeding which I've never had before, or I haven't had in five years, but it's not new, but it's been five years, and so I'm minimizing that. It is easy and common for me as that patient to just fall back into that familiar thinking and just make assumptions. All right. It's a lot of work, whether you're a patient or practitioner, it's a lot of work to constantly clear the slate, if you will, talking to talking to the other half of the coin, whether I'm a patient talking to a practitioner that I know well, or practitioner talking to a patient I've seen for a long time. It's a lot of work to clear the slate and say, let me just go through my checklist methodically and be sure I've thought about A, B, C, D, and E, even though I've thought about that for the last five visits in a row and we've ruled those out. It's all part of the work and it's in the best service of the patient and it's in the best service of yourself as a practitioner to not be not find yourself, to not put yourself in a precarious position. It is extra work, but it is worth it on all levels. All right. And for those of us who have been around longer and more experienced, yeah, it might, we might be able to do that faster or with more reassurances. But in the end, the more comfortable we are, just watch out. All right. Being comfortable is not always a good thing. It's nice at times. That's more, we have more experience, we're more comfortable, we're more familiar, the learning curve is lower, there's fewer learning curves, but complacency can be a real meaningful and stealth enemy, all right, for us as practitioners. And again, as patients, not only are you doing yourself a better service by not necessarily just making presumptions all the time, but when you present your symptoms to practitioners, especially those who you've been working with recurrently, it's by presenting it with presumptions and labeling it as this or that or inferring that you know what it is and that it's the same old. It insinuates and infers and only serves to cause the practitioner to start thinking in those same lines and make assumptions. But in the end, it's not mean this is not meant to like create ourselves extra work and just be all liability-oriented. But first and foremost, for the sake of clarity within ourselves and with our practitioners or with our patients, it's important to just be clear within ourselves first and foremost about how we're thinking these things through, and then do our due diligence, even if it only takes a minute or so, to rule out this and that by by verbalizing and communicating clearly within each other that yes, this is the same as usual, that yes, these things that you're asking about are not anything new and correct. I'm also not bringing to the table as a patient any new symptomatology. And so you can be reassured that we don't need to think about other topics. All right. The differential diagnostic list, meaningful step in the evaluation of any patient, no matter if they're a new patient or have new symptoms, or it's an ex a well-known patient and someone who is presenting with what seems initially like the same symptoms as usual. All right. That, my friends, is definitely the reality of medicine and especially the intersect of functional and conventional medicine. It is not an easy place to be. I am very fulfilled with it, practicing in both worlds, being open to all tools in both the conventional and functional medicine world. But man, it's many times even more work. Worth it, but it's more work. So, practitioners, let's just do ourselves a service and guard ourselves and remind ourselves, all right, about best practices and patients. Please be aware of the kind of impact you can have on your practitioners by the way you present information. And just know that it's not always the same old. Peace to you guys, and we'll talk again next time. So fresh, just the way you like.