Rods and cones are missing exactly where the optic nerve leaves the retina. That location is called the papilla or blind spot. It would perhaps have been better to indicate the corresponding part of the visual field, because that is where the blind spot actually manifests itself. However, we are not aware of this because our brain fills in this missing part of our field of view.
Our medical knowledge is full of blind spots. Doctors know they don’t know everything – and more importantly, they can’t know everything either – but their brains are very clever at masking this. Anything that cannot be explained can be labeled with some kind of label. This is certainly not lacking in medicine, because puzzling findings that cannot be hidden under terms such as ‘functional’, ‘essential’, etc. make doctors uneasy.
Sometimes you wish such a puzzling finding had never come to light. Unfortunately, that fate befell 30-year-old Natascha. She suffered from fatigue and headaches. Doctors then quickly speak of ‘vague complaints’ and that is where the trouble begins: firstly, patients do not experience their complaints as vague at all, and secondly, there is something dubious about the word ‘vague’. Patients quickly notice that they are taken less seriously.
Natascha was not anemic, but ferritin was too low. In 1982 it dedicated Dutch Journal of Medicine a article to ferritin. Few doctors then had ever heard of this protein that stores iron in the body. However, in four decades, ferritin has become a linchpin in anemia research. Well-informed patients are also aware of this. With willing GPs, they can arrange a lab determination by e-mail or telephone.
‘Blind spots in medical knowledge are the ideal domain for private clinics and alternative therapists’
Natascha’s vague complaints led directly to such a bad blind spot. A ferritin that is too low without anemia is rarely or never seen in general practices. The explanation is simple: usually ferritin is only determined in anemia. Natascha made it very difficult for her doctor. After a course of steel tablets, the Hb (hemoglobin level) rose but the ferritin dropped to an even lower level. That wouldn’t sit well with me as a doctor.
For the time being, the doctor’s assistant advised Natascha to continue with steel tablets.
When doctors are confronted with a blind spot in their medical knowledge, we can assume that patients in this situation have the necessary questions. So is Natascha: is there a relationship between her complaints and the laboratory results, what is the reason for her extremely low ferritin and – above all – what is the treatment for this?
Blind spots in medical knowledge are the ideal domain for private clinics and alternative therapists. Regular doctors are not eager to send patients here. But patients with vague complaints do feel they have let them down. It is now also known in regular medicine that too low ferritin without anemia can cause fatigue and headaches. Hope is pinned on an iron infusion at a private clinic…
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