Ring-a-ring o' rosies,
A pocket full of posies.
A-tishoo! A-tishoo!
We all fall down
Many of you, dear readers, are probably very familiar with this well-known nursery rhyme which has been linked to the Great Plague outbreak in London during the 1600s. The “rosies” being the typical rash seen in the first stages of the bubonic plague infection, the “posies” a supposed preventative cure, the “A-tishoos” signalling the next stage of symptoms in the disease process and, finally, “the falling down”, implying the final stage which was, well, death!
We may not all believe these rather macabre interpretations of this little ditty; however, its fatalism does emphasise for me one specific issue … the importance of an early diagnosis, to basically help prevent a serious illness, and sometimes even, well, death.
The ability to diagnose diseases in their early stages not only increases the chance of a successful treatment, it can also greatly benefit public health by limiting the spread of infectious diseases.
Early and timeous detection and treatment of certain diseases, like colon, breast and prostate cancers (to name the most obvious), can lead to better outcomes and even complete cures, as the disease in its initial stages is more responsive to treatment, reducing the risk of complications and improving long-term health.
In a recent interview, Dr Zhou Lihan, a prominent Biochemist involved in developing mRNA technology for cancer research, said: “Countries which focus on early diagnosis not only achieve better survival rates but also reduce healthcare costs overall…”
One of the major reasons for a delayed diagnosis is poor symptom awareness, i.e., a patient may not realize that a symptom is important. Partly due to poor patient education and an over-stretched healthcare system, it can lead patients to adopt the ostrich head-in-the-sand attitude, not wanting to “bother” their doctor with symptoms which may be trivial to them but vastly important to the clinician.
This is also not helped by certain healthcare systems restricting the time allocated per consultation and not allowing for more than one symptom being discussed at a time. Clearly this measure was meant to reduce patient waiting times, but, in my opinion, it is more of a recipe for poor diagnostics and poor patient outcomes.
Obviously, some minor symptoms do not always need to be assessed by a medical professional, and I agree with the opinion of some Harvard Medical School doctors who advise that early testing may be a waste of time, money and effort, as many simple health conditions simply resolve on their own. Repeat and more invasive testing for relatively minor conditions can lead to unnecessary procedures and increase patient stress and anxiety, when sometimes the “cure” is simply the passage of time.
This is where our common sense and proper patient education are so vitally important to help balance out these two viewpoints and attitudes.
Take for example a common cold. Generally, a simple, self-limiting viral infection. However, rapidly worsening symptoms can be a sign of something more serious like Influenza or Covid or a secondary bacterial infection. Unfortunately, even though the pandemic educated the public about the availability of rapid point-of-care testing for specific infections (such as Covid), it has also imprinted on us the idea of just “stay at home and deal with it”. And the intensive recurrent testing has also made us very reluctant to do any form of exams whatsoever, as apparently “there is no cure”, so why do you need to check?
What the general public fails to understand, though, is that there are other conditions (like Influenza) which can be treated with specific anti-viral medications, but treatments should start within 72 hours of developing symptoms. Even with Covid, knowing the diagnosis can help us start preventative medication and anticipate poor long-term outcomes. And this is where simple, quick, diagnostic tests can be crucial.
Knowledge is power and making a clear and final diagnosis is key to correct and timeous treatment options. We all use the latest tech gadgets without the bat of an eye, so why not take the same advantage of how technology has advanced medical testing?
So, let’s not let ourselves get to the “fall down” stage … I would far rather see a patient with a “simple cold” that I can properly diagnose and treat early than a seriously unwell and deeply breathless one that needs urgent hospital admission, simply because they thought it was just “a virus”.
A-tishoo! And bless you…
