Diagnoses Multiply, but the Body Is One

This month's calendar has three circles on it. One for the knee, one for the stomach, one for dizziness.

There is nothing wrong along the way that led here. When the knee hurts, you go to see about the knee; when you are dizzy, you go to see about the dizziness. Looking for the right place for each symptom naturally leads here. Nor is this unusual. Among people over 65, more than half live with two or more chronic conditions.

Why the Same Body Gets Different Names

The name of a disease is a word compiled from what was seen in that particular examining room at that particular time. Different things looked at, different things measured, produce different words on record. In one place, someone looked inside the stomach and wrote it down; in another, someone wrote down a number measured from blood. It was the same body, but what was in hand was different.

And time passes in between. Between a name given three years ago and a name given this year lie three years. If the two names differ, the body itself may have changed in between. Each name may be an accurate record of the body at that particular moment.

That does not mean the names are meaningless. A name has to be attached before what to look at and where to begin treatment can be decided. Why diagnoses keep changing covers this point separately.

Even With Many Names, Only a Few Signals Come Out

The signals the body sends do not increase in step with the number of names. They overlap instead.

No energy, no appetite, a slowed gait, shallow sleep, persistent dizziness. The complaints that surface with age usually fall into these few categories. But these few categories do not belong to only one disease. Many diseases with entirely different names all surface through them.

Geriatric medicine sets these apart from disease names and calls them geriatric syndromes. Because factors spanning multiple systems act together to produce a single presentation, they do not fit neatly into a disease classification. One study lined up five representative examples — sudden confusion, falls, urinary incontinence, pressure sores, and the loss of ability to carry out daily activities on one's own — and looked for what lay beneath them. Four risk factors were found in common across all five: age, the degree to which memory and judgment have grown unclear, the capacity to carry out daily activities independently, and how much mobility remains.

This does not mean these four are the cause of each syndrome. But because different syndromes share the same underlying background, the way they surface overlaps too. This is how symptoms arise that no one can say for certain which name they belong under.

When Something New Gets Filed Under an Existing Name

When there are already several names, whatever appears next usually gets filed under one of them.

If someone whose knee always hurts finds it hurting more lately, the knee is blamed. If someone whose stomach has been unsettled cannot eat at all, the stomach is blamed. If someone whose memory has not been what it was grows confused for a few days, that is blamed too.

There is a reason this happens. That disease genuinely does produce such symptoms sometimes. And once a new symptom is explained by an existing diagnosis, there is less reason to look further. The patient comes to see it that way, the family reports it that way, and in the examining room it is easy to settle it that way too.

Medicine itself flags this as a common path people fall into. Attributing a newly arisen symptom back to an existing diagnosis is called diagnostic overshadowing. This does not mean anyone was careless — it means this is an easy path for human judgment to fall into.

So one question remains. Do the names already attached explain every symptom that is currently there? If even one thing is left unexplained, that one thing needs to be examined on its own.

Where to Look First

There are three situations where this question becomes especially urgent.

When confusion sets in over a few days. When someone repeatedly mixes up people or places, keeps losing track of what they were saying, or is clear-headed in the morning and confused by evening, over and over. Even for someone whose memory was already unclear, if this develops over a matter of days, it is a different signal.

When a longstanding symptom changes shape. When the location of pain is the same but its timing or intensity has changed, or when something that was not there before now comes along with it.

When the change happens within days. If something that used to develop over months now arrives within days, that may not be the usual pace of that disease.

If even one of these three is present, reassessing the names comes after that.

Lay It All Out, and the Spaces Between Become Visible

Adding one more name does not sort out the ones that came before.

I ask patients to bring in every piece of paper they have received so far. Then I lay them out by date. That makes the time between the names visible. Digestion faltered first, sleep grew shallow much later, and pain appeared after that. Each examining room only recorded the body as it was on the day it was seen, but laid out together, the space between them sometimes turns out to be continuous.

Laying them out does not merge the names into one. Each name has its own course of treatment, and that treatment is not replaced here. What laying them out reveals is order. Simply separating what came first from what came later already changes what can be seen.

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This body has been looked into in several places, and just as many names have been attached. That record is worth keeping together.

But no matter where or when those names were attached, the day itself is not divided up. The knee, the stomach, and the dizziness do not arrive on separate days of the week. They arrive together, in a single morning.

Counting how many names there are tells you less than how that one day is actually passing these days.

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)