Z is for Zebra

This was one of the easiest letters to pick.  The Zebra is the mascot for carcinoid cancer because physicians are taught that 'When you hear hoofbeats, think horses, not zebras."  This is excellent advice and is an example of Occam's Razor.  Essentially, the answer that has the fewest assumptions should be selected.

Carcinoid mimics many other more normal diseases like irritable bowel syndrome, Crohn's disease, stress, gluten intolerance, or any one of number of other diseases.  In spite of my misdiagnosis, this is exactly what a doctor should do.  You should choose the most likely situation but (and here is where my doctors originally fell short), you also need to keep the zebra in mind when the horses don't materialize.

The misdiagnosis in my first years were not outside of the horse arena as my symptoms were quite minor.  In the final months, that is where the zebra should have started making an appearance in my doctor's diagnostic sequences.  On the other hand, it is certain that the few months of misdiagnosis would not have lead to any difference in my current situation.  However, if it had been caught several years earlier, that diagnosis could have lead to a potential full cure.

But at what cost?  The blood test is pricy, nuclear medicine scans are extremely pricy, and neither may have been definitive.  This sort of shotgun testing is a significant part of our healthcare cost explosion in the last few years.  Doctors order batteries of tests because it is easier to just administer a test and it is safer from a malpractice point of view as well.  These tests are often not cheap (CT Scans and MRIs for minor head injuries) but they are a quick and easy way to rule out certain diagnosis and to CYA.  Doctors are also not the only ones at fault here as patients demand or expect this tests to be done in order to ease their mind about the possibilities.

We need to get these costs under control.  Zebras need to be considered but they need to be addressed further down in the diagnosis tree rather than pushed up to the top.  Without getting these costs under control, healthcare is going to continue explode.  Whether you like it or not, the Affordable Care Act is attempting to implement some controls that will use the carrot of higher payments for doctors and hospitals to implement more efficient care.  This already has proven effective in some areas such as reducing hospital recidivism through follow up care and doctors visits.

Are you a zebra too?  Perhaps.  Follow the diagnostic tree through the most likely illnesses.  If you have a fever, almost certainly,it is flu or a head cold and you don't have ebola.  Even malaria or typhus would be a more likely diagnosis than the albino zebra of ebola.    Attack the most likely situation first and save the expensive or invasive tests until later.  I had this exact situation about 4 months ago when I had persistent low grade fevers (100-101) every evening.  We checked the easy, cheap, and higher probability causes and then waited to see if my scheduled stent swap would solve a possible UTI.  It did and no more tests were needed.

Doctors need to be given the time to go through proper sequences and then also need to not be punished (sued) for missing the 1 in a million case.  Be patient as they try to diagnose you because medical science is not as precise as we would like due to the amazing complexity of our bodies.