Is your clinician treating the “root cause” of your problem?

Possibly not, but the reality is that we’re still figuring out the root cause of most things!

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Is your clinician treating the “root cause” of your problem?

Possibly not, but the reality is that we’re still figuring out the root cause of most things!

Let’s say you’ve been feeling really tired lately, so you go see your clinician and they ask about your stress levels and run a bunch of labs, maybe even a sleep study. But everything is normal. Now what? How do you fix being tired if you don’t know what the cause is? Most people have had a similar experience, where a clinician tells you that all your labs are normal, but you still don’t feel great. A lot of us feel frustrated because our clinician hasn’t given us actionable information. This can make us turn to people on the internet who say that medicine isn’t interested in the “root cause” of the problem. But…

Finding a simple "root cause" isn't so simple

For many conditions, there might not be a single, easy “root cause” that explains your symptoms. Sometimes, there’s a beautifully basic root cause: if your arm is hurting because you broke it, we have a root cause. Clinicians are able to put a cast on it, and your body handles the rest. But for a lot of conditions, it’s not that easy.

Even for something like high blood pressure, which you might think has a simple single “root cause,” there are often countless factors at play. For example, eating high-fat foods or regularly smoking cigarettes could contribute to atherosclerotic plaques. Atherosclerotic plaque is a buildup of cholesterol and fat that can stick to the sides of blood vessels, making the blood vessels narrower and stiffer. As a result, higher pressure is often needed to make sure enough blood gets through. Typical treatments would be blood pressure medications and a heart-healthy diet. But even with something like atherosclerosis, risk factors like genetics and environment also play a role. And sometimes, high blood pressure can be “idiopathic”, meaning there isn’t a clear reason why someone develops high blood pressure–they just do. But regardless of the reason underlying someone’s high blood pressure, we still treat it the same way: lifestyle changes and blood-pressure-lowering medications.

Root causes don’t always equal cure

For some conditions, although we know the root cause, our ability to treat it is limited. For example, sickle cell disease is caused by a genetic mutation in a hemoglobin gene. Hemoglobin is part of red blood cells. The mutation causes red blood cells to change shape when someone is dehydrated, stressed, or sick. The shape change causes the symptoms we often associate with sickle cell, such as anemia and extreme pain. Unfortunately, we can’t help sickle cells keep their shape, but there are medications[archived link] for pain control and some medications that actually encourage the body to produce different types of hemoglobin that make regularly-shaped blood cells. We know what the root cause is, and many scientists are working on potential cures for genetic conditions. In fact, there are new gene editing [archived link] drugs on the market for sickle cell that look like they might effectively be a cure, but this comes with a hefty price tag, so it might not be accessible for everyone right away. For many other genetic conditions, like sickle cell, we just don’t have a cure yet. So we have to treat the symptoms instead of the root cause.

Sometimes we don’t know the root cause (and that’s okay)

In other cases, we don’t know the root cause at all, but we can treat the symptoms to help patients feel better and improve their quality of life overall. For example, endometriosis is a condition where uterine tissue grows outside of the uterus. Endometriosis can cause intense pain with your period or pain with sex. There are a number of theories about why this can happen, but we don’t have a definitive answer yet. Here, we’re limited to treating the symptoms with hormone therapy or removing the tissue with surgery. Conditions like back pain, which almost everyone has at some point, can also have varied causes. Back pain can be due to anything from a herniated disc to not sitting in the most body-friendly position. Most of us have experienced back pain that just happens out of nowhere and clears up in a few days. But in the case of back pain, the root cause often doesn’t make that much of a difference in treatment [archived link], which is generally physical therapy and pain-relieving medication. Sometimes, we can’t pin down anything definitive, like with generalized fatigue. But we can still help treat the symptoms to improve quality of life.

If I’ve learned one thing while in medical school, it’s that the body is really complex! Everything is connected, and a lot of factors can go into even the most common and treatable conditions. But there is a lot we’re still learning about the body, genetics, and treatment. That’s what’s so great about science: there’s always something new to discover! If we know how the illness itself is caused, we’re often able to treat it directly. But sometimes we’re stuck treating the symptoms until we’re able to better understand the root cause itself. And even when we discover new things, there are often nuances (based on things like medical history, allergies, etc.) to ensure each person’s treatment is appropriate and effective.

It’s understandable to feel frustrated when there might not be a concrete solution to a symptom you’re having. It’s upsetting when you feel like your concerns aren’t being addressed, especially when you’re just trying to feel normal again. That’s why finding a clinician that you trust and one that will work with you to get you to a place where you feel better. It's ok to ask your clinician what they are thinking and why they are recommending what they are. You can share your frustrations or concerns so that they can better answer your questions. In the meantime, scientists are going to keep working on figuring out how to treat diseases. Maybe one day we’ll understand the “root cause” for every medical problem.

Further reading:

Those Nerdy Girls - How do I best navigate a healthcare appointment

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