05/22/2022
Welcome to ZebraEnthusiastMD, originally just a login name for a social media account, but now my chosen "code name" in this "medical underground," as Anne Maitland is fond of saying. Zebras are patients in whom (subjectively) nonspecific symptoms are due to an uncommon condition rather than a more common one. Patients with such symptoms due to common conditions would accordingly be "horses." Although these terms stem from a borrowed saying that was designed to reassure medical trainees that recognition of common conditions is often all that is required in the practice of medicine, there was a time not long ago when being able to recognize and treat "Zebra" conditions was the most esteemable trait a physician could possess. In less than 20 years we have seen that kind of diagnostic skill and medical knowledge lose its value among average physicians to a point where physicians who consider unusual diagnoses are often castigated by their peers. There is no doubt that we are witnessing a dumbing-down in medicine, and the driving influence is fairly clear: big insurance companies and hospital corporations. "Zebra enthusiasts" (aka inquisitive, well-read, humble physicians) everywhere are being forced to choose our company carefully when discussing poorly-understood conditions, particularly those in which data is still largely observational. How quickly we forget that all big discoveries and revelations in medical history start with observation! Unfortunately some of these conditions are much more common than was ever believed and the present attitude towards change is leaving millions neglected. Personally, I have always had a special predilection for patients with unusual conditions who are instead mislabeled with diagnoses that cannot be proven or disproven (IBS), and for those who our modern medical algorithms routinely fail. The "MD" is attached because I believe that there is still hope for our profession. I would submit that for all the talk of "burnout," physician dissatisfaction is much more likely related to the detachment from our patients, electronic records/documentation, insurer-directed treatment algorithms, and predatory malpractice suits than it is work-life balance and hours. Despite my own heartbreak when I was recently faced with the fact that a well-trained partner preferred willful ignorance (if not deception) to addressing new concepts, I do continue to meet physicians who go out of their way to help hEDS patients when others will not, and without regard to lost time and income. I have to believe that in the near future Zebras will start getting what they need. Work at the Norris Lab should help achieve this. As far as the fate of medicine in general: if we can only pry control away from big business--the large insurance corporations and hospital systems that actually dictate care--we may be able to get back to our roots and regain control of this potentially noble profession.
