Thinking Activity In Medicine

Doctors are supposed to be smart. In most countries a student needs several years of higher education in order "prove themselves" and get into medical school. Information retention is important in medical school but a higher emphasis is put on solving problems. Thinking as an activity is really only studied in epistemology, a field of  philosophy. The following cases show how important understanding thinking is in making the right, often life-saving, diagnosis.

1. Pigeon-Holing

pigeon holing

One of the most common errors in diagnosis is pigeon-holing. This occurs when a doctor forces a cluster of symptoms inappropriately into the wrong workup pathway. There can be many reasons for this. A common saying is "if you don't think of it, you won't diagnose it." If the concept is not in our heads due to lack of experience or lack of study- we may not even think of the real reason for a problem. Many of these errors act in concert with each other.

One popular path of treatment is the "chest pain work up." This path entails looking for life-threatening problems like pulmonary embolism (blood clot in the lungs), aortic dissection (ripping open of your biggest blood vessel), and heart attack in a person with chest pain. It is possible that pain in the upper belly can be a heart issue. I have seen patients given a huge and expensive work up for chest pain when every symptom pointed to their gallbladder- this can be a tricky balance as it may be reasonable to rule out heart/chest pathology before chasing down the gallbladder.

The solution here is a little patience- gather more percepts (listen to the patient and look at tests) before jumping to a conclusion. 

2. Diagnosis Fatigue

diagnosis fatigue

We just admitted three patients with shortness of breath. The fourth patient also has shortness of breath. The three prior patients all were effectively ruled out for blood clots in their lungs. Surely this patient doesn't have a blood clot! And they have borderline kidney function so we don't want to order a CT scan to rule them out as the iv contrast dye might cause complications. We convince ourselves that we don't need to think about this diagnosis. It is just some bad bronchitis. This could have fatal results (I have seen this). The treatment of blood thinner is very different than the treatment of breathing treatments, antibiotics, or steroids. 

We need to keep an open mind and not allow prior patients' results affect our current situation.

3. Red Herring

red herring 

Too often do we find an abnormality in a diagnostic test and place undue weight on this result. The most common places I see this error in thinking is diagnosing a urinary tract infection and pneumonia. A urine test often will show some signs of white cell activity in the urine and even signs of bacteria. Sometimes this is related to not having a clean catch sample and cells from the outside contaminating the sample. Sometimes it is an indwelling catheter and other times it is asymptomatic bacturia (this only needs treated in pregnancy). With pneumonia commonly a chest xray shows a possible abnormality that could be atelectasis (squishing together of the lung from laying in bed too much). The problem with red herrings are that the treatment may be misguided and the work up may be stopped too soon.

Solutions to red herring is to always question yourself at least a little. Wait to make the final diagnosis.

4. Soothing Thoughts 

no evil

It is possible to talk ourselves out of a diagnosis that we know is correct. This patient is not septic- they are a little nervous that is why their heart is beating faster and they are breathing hard. They are dehydrated, that is why they have a high white blood cell count. The right concept is there, we just talk ourselves out of it. It is alright to doubt ourselves- and even healthy- but we should have a back up plan. Which tests or treatments can we order to try to verify that we are right or wrong? 

5. Living in the Fast Lane

fast lane

When we are rushed it may be impossible to not not be biased in the above ways. It is important to not allow the stresses of a job influence our objectivity and to always listen (95% of the time the diagnosis can be made simply by speaking with a patient). If we are stressed and rushed the world may close itself off to us. Medicine today is far too rushed. This is a reason the direct primary care model has become so popular- patients and doctors don't feel rushed anymore and the right diagnosis and treatments can be found.

Try to have an inner barometer of how rushed and stressed you are. If you feel hurried- take time to slow down. 


Threefold Path to Understanding

The three systems of nerve-sense, metabolic, and rhythmic system are key in virtually all living organisms. We can appreciate this basic observation as way to humanize medicine as we can understand remedies more easily as well as understand disease processes. The plant has a root, leaf, and flower. The human has a nervous system (focused in the head), a rhythmic system (circulation between heart and lungs), and a metabolic system (digestion, movement, and reproduction). It helps to observe the qualities of both in an objective way. 

Root and Nerve

The root of a typical plant is the most fixed and solid of its structures. It is immobile. In transplanting a seedling or a tree it is the root that is the most sensitive to the process. It is branched and if allowed to grow unobstructed will usually grow with a symmetry like an upside down Christmas tree. Roots are typically white and grey colored with the exception of roots of plants that have special nutritious qualities or medicinal properties. It is the exceptions to the rule that help us see the rule. The root is also typically buried or covered.

The brain is immobile and actually nearly weightless. It floats in cerebral spinal fluid which cushions any movement it might encounter. There is a grey and white color to nerves. They are branched in their fundamental shape. Nerves are also covered. The skull and spinal canal form a cover for the main nerves in our body. Only in the sense organs do the nerves approach the outer world. The eye is one special place we can see a nerve. It can interact with the world but at a cost- it is constantly broken down. If a nerve is uncovered such as by a cavity in our tooth we feel extreme pain. 

Leaf and Circulation

leaf heart lung

Leaves are typically green. Chlorophyl is present in the leaf and the porphyin molecular ring is a light catcher. Inside the ring of chlorophyl is magnesium (a metal that readily shows us its relation to light in that it burns with a brilliant brightness). Oxygen is produced from the interaction of light and chlorophyl. The rhythmical movement of the sap of plants is dependent on the sun.

In humans we see a mighty reversal. The sun is internalized (as are the planets working on the earth in our other organs). Our blood is given rhythm to move through our body by our heart. Nearly the same porphyrin ring is used in our blood as hemoglobin. Iron is placed in the middle and oxygen is carried to the cells. Our blood is red- the complementary color to green. 

Flower and Metabolism

flower metabolism

Typical plant reproduction occurs through the flower and all sexual reproduction occurs this way. In the typical plant the flower opens and closes through the day. It may follow the sun. Flowers are the main point where plants interact with their environment. They also have a high metabolic activity1- some flowers like skunk cabbage push this to an extreme in their capacity to produce heat.

Humans interact with the world through their limb system. We are able to freely move around the world at large. This system is warmth generating and metabolicallly intense. We also have internalized reproduction- plants do not sprout their seeds inside of themselves. 

The picture above is a brief outline of the conception of the human as an upside down plant. We can further understand this threefold nature by looking at sulphur, mercury, and salt. These alchemical principles relate to the metabolism, rhythmic system, and nervous system in the human. They relate to the flower, leaf and root in the plant kingdom. 


Animals and Humans

The idea of evolution has been readily taken up by most of modern civilization. This idea can nourish science but there is a danger in a materialistic interpretation. The common interpretation is that we are descended from one or another of a prehistoric species. A humanized understanding will see the need to account for the question of "where did the spiritual in humans live then?" Animals bear human qualities- one could say they bear them to an extreme. When we humans act to an extreme we are called animal names. Looking at human and animal development we can observe ths more precisely. Humans stay unspecialized, undeveloped through their entire lives. Animals develop early and specialize early. 


A look at our brothers the chimpanzee can be insightful. As babies they have the most human-like features to their faces. As they age these quickly change as the jaw thrusts forward. The head is also carried forward and the forehead slants backwards. 


The chimpanzee fetus has hair growth that resembles the human up to a month prior to its birth (at 8 months). We humans retain this feature (unless we go bald) our entire lives. This is true of many anatomical features. Animals descend into matter deeper than humans. They are better adapted to the physical world. Humans stretch out our life phases as long as possible. We have a very long development in the womb. We have a longer childhood and reproductive years. Most species will die directly after reproduction but we have a long post-reproduction phase. 

The animals bear within them a part of the human spirit showing us a side to ourselves. The chimpanzee and pig both have a special relation to humans. We see this medically as the two closest studied creatures to us (rodents are most often studied due to their ease of containment and low cost). In the pig and the chimpanzee we see two animal brothers that relate very closely to our "I am" nature. The chimpanzee bears the closest part of our physical form. The pig has many of the soul features and physiologic features that relate to our unique being. The geneticist Eugene McCarthy is a keen observer of the traits in pig, chimp, and human. He hypothesizes that pigs and chimpanzees hybridized long ago in order to spawn human ancestors. Though this is possible, I feel it is again a materialistic search for the human in animals- we can more readily find the animals as spiritually pre-descended (descended too early) from the human. It is interesting that we see in cultures who live close to these creatures a cultural or religious ban against eating the flesh of both of these creatures.


Uric Acid in Human Life

Humans and a few primates are unique in that we lack an enzyme called uricase to to change uric acid into a compound we can excrete easily in urine. Uric acid is generated as a breakdown product of nucleic acids (specifically purine) and there is evidence of the trend that structural compounds when broken down exert effects at the level of consciousness. Humans actually have the gene for uricase- it is just permanently silent. The inhibition of this powerful enzyme points to a greater wisdom- that there is a reason for uric acid in the human.


In animals we find that birds and reptiles are able to excrete uric acid alone. Fish excrete ammonia (aquarium keepers must always be on guard about keeping the levels of ammonia in check). Mammals produce the intermediate urea for urinary excretion of protein byproducts. From fish to mammal to reptiles and birds we see that ammonia, urea, and uric acid has more and more a water to solid tendency. Uric acid forms crystals in gout and kidney stones. Birds (formed from mainly head forces) occupy the air element but their bodies are far more earthly than mammals. The crystal-leaning substance of uric acid exemplifies these head-forces. Rudolf Steiner pointed to thinking as a finely distributed crystallizing process of uric acid in the brain. He indicated that an imbalance of uric acid in the urine versus the blood would be associated with sleep disturbances. The graph from a study linking these variables is a modern confirmation. 


In gout we see the process of excretion of uric acid happen inappropriately into joints. Gout can occur because of too much uric acid being produced or because of too little being excreted in the urine. The I activity is not able to fully take hold of the process and the astral body attempts to compensate. The astral forces are inward working forces and we see uric acid crystallize in the joints- typically cooler peripheral joints away from the warmth of the I activity. The kidney (the astral body's seat in the organism) also bears these uric acid crystals. Interestingly we see gout associated with too much astrality in our foods (rich, meaty foods) and with alcohol (a dampener of the I activity).

Lesch Nyhan Syndrome points to the head and nerve focus of uric acid as well. In this genetic disorder, uric acid accumulates to extremely high levels. Behavioral disturbances occur, the most typical being a compulsion to lip biting that can cause tragic disfigurement. 

Some Powerful Relatives

Uric acid caffeine

We can see that uric acid ties itself to thinking and consciousness by looking at some relatives. Caffeine is present in coffee, tea and chocolate. Steiner commented on the differing quality of effect from consuming coffee versus tea. There is now genetic evidence that caffeine production by plants occured by different pathways in tea and coffee. Theobromine is the compound in coccoa which acts on the heart and kidneys (but not on consciousness directly). 


 Theophylline is an asthma medication that relaxes the smooth muscle of the airways. It also has effects on the heart and kidneys. It commonly causes anxiety and insomnia. Coccoa is one of the best natural sources of theophylline. 







The barbiturates are a clear example of how uric acid can move the other direction in affecting consciousness. 


Different Ways of Being Conscious

Consciousness exists on a spectrum that we can look at in three main stages for humans. These levels can co-exist as well- sometimes causing discord in society as a new generation grasps existence at a level the predecessors did not. The basic level of consciousness is a group consciousness. There is no center just a periphery.


Forces influence our emotions and desires and awareness from outside of our domain- without really interacting with us as an individual. The "tribe-consciousness" has a benefit. We are always conscious of our group. But this consciousness does not extend to other groups. At its basic element the individual is not experienced except as a dim part of the group. 


This consciousness does not tend to fit our modern life well. We have moved through a phase of point consciousness. The insdividual is essential in this level of consciousness. At its best we experience ourselves as one individual among other respected individuals. We can have a real fellowship with others as we know that other "I beings" are in our midst. Taken too far we see all the results of egotism. This tends to be stronger in the Western world than the East. The individual can neglect to even think of other individuals and only think of him/herself. Environmental destruction, consumerism, rifts between rich and poor and other issues grow from this. This point consciousness is really a double edged sword. We need it to be free and to experience the world in an independent and clear objective manner. But it can be destructive. 

I have seen others (and have been of the opinion myself once) that these two levels are the only way to experience the world. If so it would be justified to extinguish the self permanently and go back to group consciousness as much as possible. There is another way forward- and giving up on human consciousness is like giving up on the sun after it sets. But the sun will rise again on a new day. Our new consciousness has been starting to arise in earnest- despite the forces that try to keep the old consciousness (and the traditions it goes along with) intact by politics, force or other ways. 


Understanding the self is actually in the other and the other is in the self is essential for this new way of seeing the world. We are not just the point and not just the periphery. We exist in unison. At the heart of our social and cultural movements we see that this is living. 

It is not possible to be in favor of justice for some people and not be in favor of justice for all people. — Martin Luther King Jr.

Martin Luther King's central impulses were informed by this principle. We can call it the consciousness soul. As opposed to a group consciousness- which would actually generate racism as one group is noted as the "other", consciousness soul takes a different tact of identifying with "the other". This activity is quite new in human consciousness. Environmental concern stems out of an understanding of experiencing one's place in their surroundings. 

A healthy social life is found only when, in the mirror of each soul, the whole community finds its reflection, and when, in the whole community, the virtue of each one is living. --Rudolf Steiner

Human struggle in all realms is informed by this shift in consciousness that no one can stifle. In order to find this consciusness I find that a new way of thinking is needed- just as individual point consciousness needed to develop logic and material science (that we should not throw away). A new language is needed just as a wine taster needs a way to describe their complicated experience interacting with the substance they imbibe so do we need languuage to describe the new experience of being conscious as human beings today. 

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