Diagnosis: Identity or Ownership?

To be, or to have? That is the question.

Ever notice how often certain diagnoses are used as identifiers? Diabetic. Autistic. Schizophrenic. Epileptic. Some of them also work in the possessive: one can have diabetes, or schizophrenia, or epilepsy. This identity thing doesn’t work as much with some other conditions: cancer, arthritis, lupus. Some diseases go both ways: “I’m bipolar;” “I have bipolar.” Certainly the diseases that become identities are often severe conditions whose manifestations and/or management pervade one’s life. On the other hand, not all such conditions become identities: cancer, heart disease.

It’s interesting to look at the grammar of the words we use. Diseases can be nouns: epilepsy, asthma, arthritis. They can also be adjectives: migraine (headaches), asthmatic, hypertensive.

As doctors, we give patients their diagnoses: “You have a sinus infection.” “You have cancer.” “You’ve had a heart attack.” This implies possession. “My leukemia is in remission.” “I’m on medication for my headaches.” Indeed, much patient literature talks about “owning” the disease.

Doctors sometimes use diagnoses as identities differently from the way patients do: “Hypertensives are more prone to have strokes.” This despite the fact that we are specifically cautioned in medical school, residency, and beyond about referring to patients by their diseases. It still doesn’t stop patients from self-identifying, or society from using diseases as labels.

What’s the difference? Huge. Going all the way back to Osler, we don’t treat the disease, we treat the patient with the disease. Patients are always more than their diseases. Always.