It’s just not that simple.
If there truly was a root cause to every health condition out there, we would be a lot further along in developing treatments and cures. The idea that a disease state can be simplified down to a single dysfunction or cause is not only untrue, but can lead patient’s a stray when it comes to their treatment and long term management strategy.
“The root cause of your PMOS is your insulin resistance.”
“The root cause of your infertility is your inflammation.”
“The root cause of your heart disease is your nutrition that is high in saturated fats.”
“The root cause of your fatigue is your iron levels.”
Don’t get me wrong, in the past I have definitely used the words “root cause” when in the office with patients, but after reflecting on the impact of this term, I am consciously trying to avoid it.
When we tell a patient we have identified the root cause of their symptom or condition we do at least 1 of these 3 things.
First, we put the “blame” on something or someone - their insulin resistance, their inflammation, their nutrition, their iron. This leads the patient to believe if they can just fix that one thing, their condition will resolve or improve. Rarely does our body actually work in this cause and effect sort of way, and patient’s tend to get discouraged when they don’t see a significant change after the initial treatment plan.
Secondly, we ignore everything we know about the body being a system. As a naturopathic doctor, I do my best to understand the deeply integrated physical, mental and emotional systems that exist in the human body. Implying that a condition has a specific root cause ignores the fact that the body works as a whole. Your PMOS isn’t just caused by insulin resistance - it’s a mix of genetics, insulin resistance, anovulation, inflammation, elevated androgens and stress. Who is to say one is the root cause over the others?
Thirdly, we don’t recognize that multiple things can be happening at once. By identifying a single root cause, you prematurely close on any other conditions that may be co-existing. Perhaps the fatigue associated with PMOS is partly due to insulin resistance, but partly due to the fact her ferritin is 9 (that’s low, the cut off for deficiency is 30).
As much as “root cause” is in reality too simple… it really does help to make the patient experience easier. Understanding that PMOS is caused by insulin resistance is much easier to stomach than realizing there are 5+ different factors that are at play that need to be addressed. Simplicity reduces overwhelm. It keeps the goals clear.
My approach as of recent has been to try and find a middle ground - to educate my patient on the multifactorial nature of their condition, but simplify it enough that they still feel in control of their health.
What I previously would have called a “root cause,” has been renamed in my brain as an “underlying factor” or “underlying mechanism.” This small change in language has helped to overcome the concerns I have encountered above, and feels more aligned with my practice.
Whether you are a patient or a practitioner, I welcome your feedback, comments and concerns. How does the term “root cause” make you feel? Does it align with you views and/or practice? Leave a comment below, I’d love to hear from you.
