The Diagnostic Dilemma – Physician Detectives

December 12th, 2015

Physicians today are faced with a problem in diagnostics that was historically rare rare in medical science. Formally, disease and injuries affected single organs or bodily systems. Today, the frequency of multi-system illness has led to remarkable discoveries in areas of autoimmune disease and the origins of multiple organ failure. A frequent cause of both is poisoning.

Poisoning through the ambient air of highly polluted industrial regions like China and India is associated with an enormous array of health problems from appendicitis to cancer. Local, self-induced poisonings usually happen accidentally. Pesticides, construction chemicals, and unsafe food preparation leading to salmonella infections cause illnesses that are ubiquitous throughout the western world. Overuse of medications can destroy intestinal functions and immunological systems.

Repeat accidents lead to an understanding of cause-effect relationships in exposure-driven ailments. Beyond that point of recognition, repeat injuries can be a sign of negligence in avoiding known harm. Ongoing harm involving minors may be a sign of criminal negligence by guardians or assault with intent by peers or other adults in their vicinities. Ongoing harm in adults can mean they are victims of negligence or assault by others. Lastly, ongoing harm from the same sources may mean an individual is engaging in self-harm, a psychiatric condition.

The new physician coding system that permits diagnostic records to authorize laboratory testing orders and bill insurance companies is called the ICD-10. It has novel categories permitting a specificity of diagnoses with the intent of identifying preventable harm. Medical costs are the single largest cause of debt in the USA today. Morbidity and mortality rates from infancy to the elderly relegate our status to that of a third world country. Tracking the causes of human suffering and fiscal instability calls our conglomerates in the industry of healing to action.

This system for diagnosing poisoning was more limited in the previous ICD-9 codes. My own disabling pesticide exposures were categorized under (989.9) Toxic Effects of Chemicals (NOS, chiefly non-medicinal in nature). No classification regarding the type of exposure (negligence) was noted in my medical records at that time. The newer ICD classes of preventable harm to various substances, be they pharmaceuticals or poisons designed to kill weeds, require a context for the harm to be identified. This example covers the official coding for a patient harmed by penicillins:

Poisoning by penicillins, accidental (unintentional) initial encounter
Poisoning by penicillins, accidental (unintentional), subsequent encounter
Poisoning by penicillins, accidental (unintentional), sequela
Poisoning by penicillins, intentional self-harm, initial encounter
Poisoning by penicillins, intentional self-harm, subsequent encounter
Poisoning by penicillins, intentional self-harm, sequela
Poisoning by penicillins, assault, initial encounter
Poisoning by penicillins, assault, subsequent encounter
Poisoning by penicillins, assault, sequela
Poisoning by penicillins, undetermined, initial encounter
Poisoning by penicillins, undetermined, subsequent encounter
Poisoning by penicillins, undetermined, sequela

The term ‘undetermined’ may include negligence and indicates the need for further
investigation. For example, an Emergency Room physician might neglect to look at
records of allergies and administer the drug. A non-custodial parent might give the
rest of a bottle of antibiotic medicine to their child, not recalling the custodial parent
had informed them not to do so. A homeowner might have notified their neighbor of
adverse reactions to their lawn care company’s activities only to suffer should the
company failed to follow new instructions by the neighbor.

Long-term sequela of toxic exposures are numerous and will assist in tracking the
ultimate results of various forms for preventable harm. Medical interviewing will
Become more comprehensive. Teachers might need to be interviewed by pediatricians
for more information than working parents can provide. Assistance to substance-abusing
teens huffing the contents of their chemically filled cell phones at school, might result
in a diagnosis of self-harm. Failure to address that returns to issues of parental neglect.

The economic implications are immense. Workplace insurance claims for illness might
be invalidated by medical histories as records follow people over the course of their
lifetimes under electronic record-keeping. It is often impossible to remove portions
of records that are inaccurate or defamatory. Long-term disability insurers can refuse
coverage after two years where mental illness is known to be present should self-harm
be part of the record. Repeated work exposures to acetone in a nail salon may, as in past
years, remove that class of workers from health care coverage. Private insurers may
refuse coverage to construction workers unless unions provide proof that OSHA
regulations are being followed (i.e. use of respirators and legally permitted materials).
Importation of hazardous materials like the banned Chinese drywall emitting hydrogen
sulfide, would lead to negligence suits by insurers for return of funds provided to sick

Financial benefits accrue to medical insurers with this system. They would be able to
insist upon restitution of funds provided for victims of negligence or assault from
criminally responsible parties. Self-harming persons would be referred for mental health
care (rarely funded in full on American policies) or suffer a loss of coverage. The legal
profession would be deluged with cases of negligence and purposeful harm. My own
legal case, (that has yet to get to court despite the passage of fifteen years since it was
filed), would not have languished for so long had prosecution been normal policy.

New Tech Industry Opportunity

The new emphasis in these codes falls upon two forms of developing technologies.
Firstly, the testing of bodily fluids will require economical and reliable methods of
Detecting residues of toxic substances. These include metabolites of pesticides and
herbicides beyond the normal three day period presently considered the time frame for
Most exposure investigations. Fragrance chemicals in unusual concentrations, tattoo
dyes, plastics known to be contaminants in some food imports, residues of un-combusted
fuels, aldehydes and other frequently encountered pollutants will be essential. Parents,
teachers and employers can assist utilizing new phone apps that analyze chemical
residues on surfaces of their surroundings. That makes the medical history more
productive in narrowing down the scope of inquiry.

Laboratories will need to expand the range of tests that can be performed environmentally
as well. I’ve personally used various tests to detect excessive formaldehyde in new
cabinetry and petroleum particulates from faulty heating equipment. This leads us into a
new era of science, medicine and accountability in the area of human health.

Categories: CDC, commentary, EPA, FDA, Life Observations, Litigation, NIH

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Comments Feed2 Comments

  1. Dr. Margaret Aranda

    The new era in science, medicine, and accountability in human health began years ago, when patients on the internet started to diagnose other patients on the internet. In my opinion, only #Stanford-X Medicine has consistently seen value to this prospect of streamlining healthcare by optimizing patient education, holding annual meetings for the past several years.

    In my books, #No More Tears: A Physician Turned Patient Inspires Recovery and #Archives of the Vagina: A Journey through Time, I teach you, the patient how to educate and SPEAK UP for yourself. The days of waiting weeks, months, or even DECADES for a medical or “Invisible Illness” should be fastly approaching. What will it take for these days to end?

    1. #Invisible Illness Petition: 586 signatures needed to reach 2,500 so that doctors are required to undergo specialized education in “#Invisible Illnesses,” as are medical students. No, it’s NOT “all in your head,” and you don’t need “a Psyche Consult.” Sign now!

    2. SPEAK UP! No longer can patients depend on the government, the insurance companies, OR their doctors to keep them well. In #Archives of the Vagina, I go over this in 300+ pages for #Women’s Health! From The First Period through all Trimesters of Pregnancy, to Menopause, MAN-o-pause, to Caregiving, Hospice Care, and Dying, I give it all to you.

    3. PATIENT EMPOWERMENT. That is the name of the new game called ‘health,’ ‘longevity,’ and ‘quality of life.’ Don’t mistake it for something else, and don’t settle for less. You deserve the best.

    Dr. Margaret Aranda

  2. agasaya

    Thanks Dr. Margaret,

    Patient groups are the main reason I’m alive today, that being the place where strangers can speak with each other and learn that our cases (deemed unusual by physicians) are frequently encountered. It’s a new day for health threats of many origins.

    Thanks for not only sharing your personal and medical knowledge, but for realizing that human health knows no boundaries as an endeavor. More than that, obligatory.

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