Medical diagnoses change quite frequently to meet the health-care needs of today’s society.
New diseases are diagnosed, named and stamped with an ICD-9 code so frequently that a new coding set with more than 2,000 codes is under way. Health-care providers can choose from a plethora of diagnoses and ailments.
Nevertheless, a new ailment is beckoning to be labeled and called upon by health-care providers, as explained by Mayo Clinic physiologist Michael J. Joyner in a recent issue of the Journal of Physiology.
However, I’m not so sure this one condition — that of deconditioning — should be allotted its own prestigious new title.
Joyner brings to light a type of orthostatic intolerance known as postural orthostatic tachycardia syndrome, or POTS. Afflicted patients experience an excessive heart rate upon standing, an increased heart rate at certain levels of exercise, and a reduction in physical exercise abilities. This deconditioning, whether primary or secondary, is one of the most common causes of morbidity and mortality in many preventable diseases, such as obesity.
This is where it gets tricky! In a statement issued on July 27, 2009, the CDC estimated that the annual medical costs of obesity were as high as $147 billion. Some researchers have postulated that deconditioning could be a secondary cause of obesity, resulting in overweight individuals being unable to exercise properly.
The creation of a new deconditioning diagnosis could help healthcare providers recognize a gap in a patient’s health status that could greatly benefit from specially designed therapies and exercise regimens, Joyner states. Along with this treatment plan, there would surely be an increase in health-care dollars spent for these therapeutic modalities.
But there are always two sides to a coin. Deconditioning is not actually a condition, but more of a complication of POTS. Would elevating deconditioning to the status of a legitimate, stand-alone diagnosis enable people who are obese to use deconditioning as an excuse not to exercise?
Americans cannot afford an increase in health-care spending, especially when a large sum is already allocated to obesity. If a person has a true medical condition, such as POTS, then by all means he or she meets the criteria to claim deconditioning as an illness. But if a person is simply sedentary in life, he or she should take responsibility for his or her health, including the need to exercise to prevent deconditioning.
Creating a new diagnosis for deconditioning might be a slippery slope. Clear-cut diagnoses are not always the answer — some patients may require a more in-depth approach to achieve certain health goals.
Clinicians must weigh diagnoses carefully for each person, and encourage all patients to be active participants in their own health. Labels or diagnoses may not always be accessible, but providing optimal care to meet the patient’s needs should not be overlooked.
Bottom line: Let’s not create an easy scapegoat diagnosis for some, but instead bring awareness to what deconditioning is and how we as clinicians can help our patients prevent or manage it.
Rachael Buitrago, CPNP, DNP, is an ANCC board-certified pediatric nurse practitioner in a private office in South Florida, and is teaching as adjunct nursing faculty at local universities.