Commitment and Consistency: Sleep Apnea In The Medical Community

December 24, 2009

With all the studies linking untreated obstructive sleep apnea with heart disease, car accidents, high blood pressure, depression, stroke, and various other common medical conditions, it’s surprising to me that not more doctors are looking for or screening for a condition that exists in 24% of all men and 9% of all women. We screen routinely for conditions that occur in 1-2% of the population that are much less deadly, but with sleep apnea, there’s a mental block that keeps physicians from diagnosing 90% of the people who have it.

Dr. Robert Cialdini, a social physchologist, in his classic book, Influence: The Psychology of Persuasion, describes this phenomenon as commitment and consistency. He states that once you’ve committed to a certain statement, truth, or paradigm, that your subsequent thoughts, words and actions will always be consistent with your original statements or actions. One simple example is an innocent lie that perpetuates more and more lies to cover up the original lie.

In medicine, we have a number of fundamental beliefs, including the fact that germs can cause illness and disease, and that antimicrobial medications can cure these conditions. Only 200 years ago, bad humors and toxins in your blood was removed with blood-letting. If you proposed back then that an unseen germ can cause illness, you’ll be laughed at or even imprisoned for such a wild and ludicrous statement. Galileo was imprisoned under house arrest for his explanation of our sun-centered solar system. I’m sure that 100 years from now, we’ll look at what we’re doing now in medicine will also seem barbaric and primitive.

Western medicine has a clinical diagnosis for almost every ailment we can imagine. There are a number of overlapping features, but for the most part, conditions such as diabetes, heart disease, depression, cold hands, migraines or diarrhea are treated as independent diseases, with different options for treatment. Eastern medicine, on the other hand, proposes that there are only a small number of basic fundamental imbalances that can lead to a number of common symptoms.

Obstructive sleep apnea today is classified alongside thousands of other common and esoteric medical diagnoses, and so to propose that obstructive sleep apnea may be the root cause of a number other other conditions would be considered heresy. Knowing that most people with heart attacks will have obstructive sleep apnea, suddenly screening and treating for sleep apnea in every patient with heart disease will only confirm that if you treat sleep apnea first, then heart disease won’t happen as much. Not only does it bruise our delicate physician egos, it also affects the bottom line for the entire medical industry, which is based on waiting until things get really bad before treating it. To go this route would be to admit that the way we’re practicing medicine is fundamentally wrong, and that would also open up liability issues as well.

Physicians and the lay public are definitely more aware of obstructive sleep apnea, but to date, we’re still treating it as a separate condition, independent of other medical conditions, rather than looking at it from the big picture. Also, despite numerous studies showing that you don’t have to be overweight or even snore to have obstructive sleep apnea, most doctors still won’t consider obstructive sleep apnea unless you fit the typical profile.

What we need is a major paradigm shift in medicine. Unfortunately, I don’t see that happening anytime soon. Do you think I’m being too pessimistic by not giving the medical profession enough credit? Please enter your reaction to this blog by typing your comments in the box below.

Written by Steven Park · Filed Under Blog | 2 Comments

Soundbite Medicine

April 28, 2009

During lunch the other day in my hospital’s cafeteria, I mentioned to my colleagues that in my recent poll of multiple sclerosis (MS) patients, the vast majority seemed to have symptoms of obstructive sleep apnea or upper airway resistance syndrome: Severe parental snoring, cold hands or feet, never being able to sleep on their backs, and frequent trips to the bathroom at night. Immediately they reflexively dismissed a possible association and attributed the symptoms to neurologic reasons.

The same situation occurs with patients as well, especially if they already have one (test) confirmed diagnosis. Any other or unusual signs or symptoms are attributed to their original medical diagnosis and a search for other possible causes is never perused.

Many people will develop obstructive sleep apnea as they age. It’s estimated that about 1/4 of all men and 1/10th of all women have obstructive sleep apnea in this country. Eighty to ninety percent are thought not to be diagnosed. After age 60, a majority of people probably have some degree of sleep apnea. If that person already has another diagnosis (such as MS), then symptoms such as fatigue, insomnia, and headaches will automatically be blamed on MS, no matter how unusual.

In the classic book, Influence: The Science of Persuasion, by Dr. Robert Cialdini, he brings up the concept of commitment and consistency. Once you’re committed to something, how you behave and think has to be consistent with your original commitment. The same process applies with medical diagnoses, to a certain degree.

In this era of information overload for both patients and physicians, it’s no wonder that alternative or additional possible explanations are not looked into once you already have another diagnosis. Not only are you bringing into doubt the original diagnosis, but it also just takes too much time and energy.

Written by Steven Park · Filed Under Blog | 2 Comments