Organ Systems Are Dumb

[@chubbyemu]

great insights. one current development that i think contributes to rethinking organ systems, among many, is the idea that gut microbiome modulates immunotherapy response in some cancers. To think that bacteria in the GI tract can affect how the immune system attacks cancer cells that originated from the skin, is well outside a rigid organ system structure

[@StrongMed]

Bernard, thanks for stopping by! 100% agree that the gut microbiome's impact on the body transcends our conventional organ system-model of pathology, and I think that contributes to our difficulty understanding it.

[@MedlifeCrisis]

Really interesting thoughts, and I'm honoured to have prompted the thought process! Like so much in medicine (and science in general), we're left with a hangover of eras gone by. As you say at the end, hard to know what an alternative model will look like though. And I'm not entirely convinced the current model is that problematic. I also don't think it's just teaching that would need to be overhauled. By medicine's very nature, we go into specialised fields. However in the UK, there's a later funnelling of knowledge, so a pulmonologist will always spend the first few years of their working life in fields like cardiology, gastroenterology, ICU, rheumatology etc. My understanding of American medical training is one branches off a bit sooner and perhaps that reinforces the silo thinking. I agree entirely that we could do a lot better job emphasising the massive overlaps between systems/organs' functions.

[@StrongMed]

Thanks for stopping by Rohin, and for giving me the inspiration for this video topic! I think the problem happens much sooner than the point when doctors specialize, irrespective of training system, since this partitioning of knowledge and the gaps in our understanding at the intersections of systems affects internists and hospitalists too. I'm not exaggerating when I say that I think the problem starts in primary school. This is probably a poor analogy, but I'll make it anyway. It's like learning physics. How much of the challenge that the average university student has in understanding quantum mechanics comes from the fact that they first learn classical mechanics? Does this bias the thinking of future physicists and make it harder for certain concepts to feel intuitive? Would science make faster progress if we introduced students to quantum physics much earlier, before an incomplete and simplified Newtonian approach to the physical world felt second nature? Or is quantum mechanics so abstract that starting with it, even excluding the math, would simply be too difficult? I don't know, but I think it's an interesting question. Anyway, loved your history of the heart talk!

[@MedlifeCrisis]

@@StrongMed I've never thought of that physics question. Very interesting, who knows how our brains might be wired differently if we did it a different way

[@ramironin2042]

I've never searched information on the subject, but when you think about it the "organ system" model is a pretty mechanistic one, based on the "body as a machine", and diseases as "a piece of the machine that isn't working properly" theories that were so popular during the Enlightenment. I think a (at least partial) solution would involve teaching biology and pathology "from cell to bedside", since the current paradigms of our understanding of physiology and pathology have become fundamentally molecular in their scope. The Lupus example you mentioned really hits the nail on the head. Lupus is a disease medical students and practicing physicians can't seem to get our head around, and part of this is because as we study diseases we place them on their respective organ system (COPD is a lung disease, stroke is a neurological disease), but the fact is that Lupus is a disease that affects every organ, and none of them! The pathologic process is not of an organ, but rather of a set of immune cells that can, in part, affect any organ. The same can be said about atherosclerotic artery disease, which is mentioned fundamentally in stroke and coronary syndromes, when it's in fact a disease of the arterial endothelium.

[@StrongMed]

I completely agree - and love the connection to the Enlightenment. (If this video wasn't a relatively spur of the moment recording, I would have looped in Corporis' KZbin channel on history of medicine - I suspect he might know a lot more about the origin of the organ system model of disease.) Atherosclerosis in particular is an interesting example because while the consequences of it appear to be organ specific (e.g. stroke, MI, claudication/ischemic limb), the understanding and treatment of the underlying problem doesn't fit into just one specialty. There are significant differences in how clinicians approach the treatment of cerebrovascular disease, cardiovascular disease, and peripheral arterial disease. I wonder how much of those differences are due to the biology of atherosclerosis being that different within different organs vs. different specialists having an incomplete perspective on the underlying process.

[@ramironin2042]

@@StrongMed Indeed! what you are mentioning regarding specialists also reminds me of an interesting fact that is commonly known: that if faced with the exact same patient, different physicians wil run different tests, prioritazing those that test "their organ", ie: in a patient with a history of chest pain, cardiologists may order a coronary angiography pretty early in the workup, in a patient with acute headache, a neurologist may choose to run a CT scan and do a lumbar puncture before anything alse. On the other hand, physicians such as those in internal medicine, or family medicine, may be less likely to focus on a single organ or a single cause of symptoms, and consider a broader clinical context.

[@sunving]

Thank you Dr Strong . Omg I missed many of your videos despite I had a bell to ring. If your project is home improvement, you are a man of multiple talents indeed. You look fit and tan. Thank you for all of your videos.

[@ryanhoyle5389]

Hi Dr Strong. Thank you for your videos they are really helping me with my course. I have been trying to categorise free online medical videos/lectures into a sort of database and it is difficult because, as you discussed, there are often topics which cross categories. As you say, there are also multiple ways of categorising knowledge beyond systems. For example in anatomy texts, regions are often used. In my medical textbooks, things tend to be arranged by specialty (e.g., infectious disease, pulmonology etc.). Textbooks themselves are often classified by subject (e.g., pathology, microbiology, physiology, medicine, surgery). One solution I would suggest (and am trying to work on) is the idea of a tagging system. For example, a specific chunk of knowledge can be tagged by system, by subject, by specialty, and by region as appropriate. For example a video on TB could have two specialty tags (ID, Pulmonology), two system tags (respiratory, immune) and several subject tags (e.g., microbiology, pathology, medicine). We can then use a simple spreadsheet to make bespoke contents lists on the fly by filtering for all content with a specific tag, or Boolean combination of tags. We see this kind of tagging system elsewhere e.g., some of the popular Anki flashcard decks. Do you think this could represent a partial solution to the problem you are talking about?

[@KaiserTota]

This may be something isolated to my country, or even my own med school, but our first year students are so stressed out about the details of anatomy (and the rigorous oral exams at the end of the semester) that physiology, a class at least equally as important, is completely sidelined. It's an imbalance of medical teaching that really didn't help when we got to the clinical years. I loved your insight on heart failure as a "pump" problem being easy to understand, and the cardiorenal syndrome then proceeding to blindside us.

[@StrongMed]

It sounds like your school's curriculum was designed by surgeons rather than internists. Not saying that's bad; it's probably best for there to be an equal mix of input. I find that at every stage of training, surgeons emphasize anatomy and pathology, while internists (and pediatricians) emphasize physiology and pathophysiology. And no one pays much attention to pharmacology, at least not as a separate discipline with content worthy of study that's independent of individual drugs treating specific organ-based diseases.

[@timrhatley]

Although there may never be a perfect way to study or treat the body, I just really, really appreciate that Dr. Strong is discussing the possibility of doing things differently and not just accepting the "standards". 👍

[@ptwarari]

Excellent. Great that you put this out here. I have worked as a Public Health Professional and the 'Systems Thinking' model only makes sense to me because of the Human Body as a system - all others being interconnected subsystems with feedback loops etc. I think that's a thinking model we can use. I have struggled seriously with the organ systems thinking - it is reductionist and creates inside the box kind of thinking, limiting our ability to integrate all the medical knowledge out there. Thanks for prompting this out of the box thinking!

[@ΆγιοςΧίλαριος]

May i ask when the next cardiac physiology video will be uploaded and if there will be any pathophysiology videos? Thnks for the huge effort .

[@StrongMed]

Probably in a few weeks. The CV physiology videos take a bit more time to make, and due to the hiatus, I want to get a few other videos out relatively quickly first.

[@gabriellabulloch6769]

Great reflections, as a first yr med student it's great to think about these things earlier and more holistically. Also, thanks for making my exams less sucky. From a thankful med student in Melbourne AU

[@vincentli1064]

Love this style of video, thinking outside of the box and inadvertently expanding medicine different from traditional medical research ! - Final Year student from Australia

[@osteoben]

Love your view on this! Thank you for posting on this interesting topic. I'm curious to know how you think then certain specialisms in medicine 'fall short' to see that multiple organs are in play, when for example a cardiologist diagnoses heart failure. Could we take this standpoint even further by saying that a specialist by definition underestimates the the influence other organs have on the pathology/symptoms of the patient?

[@rcorty]

12:37 "organ" and "organize" are both derived from the greek word for "tool"

[@unknowns334]

I had fatty liver grade 1 four months ago and ultrasound scan showed that and enzyme were elevated .yesterday i got all the results back normal i cant eat anything and i still have the same pain when i got diagnosed should i worried ?

[@StrongMed]

I'm very sorry, but I can't give specific, individualized medical advice on here. I recommend speaking with your own physician about your concerns.

[@unknowns334]

@@StrongMed does usually fatty take up to 6-7 months to cure?

[@AL-vc9xc]

The audio is amazing! Even though you are outside!

[@clarissamarie4605]

I'm not educated, I didn't even finish highschool, but I love these videos, please make more.

[@unknowns334]

Doctor , if all liver enzymes are in normal range, can you still have a liver desease ?

[@StrongMed]

Yes. For example, patients with advanced cirrhosis will usually have normal "liver enzymes" (e.g. AST & ALT), though their other LFTs will have abnormalities (e.g. low albumin, high INR, high bilirubin). Also, patients with hepatocellular carcinoma (i.e. liver cancer) in the absence of other liver disease can have normal liver enzymes. Really, all other diseases that affect the liver, when early enough, can occur with normal liver enzymes (e.g. hemochromotosis, Wilson's disease, alpha 1 antitrypsin deficiency, etc...)

[@unknowns334]

@@StrongMed i had fatty liver grade 1 four months ago and ultrasound scan showed that and enzyme were elevated .yesterday i got all the results back normal i cant eat anything and i still have the same pain when i got diagnosed should i worried ?

[@strongDr]

Agree and disagree! Integrated study is the best, but organ systems wise is still better than 'subject wise' study followed in med schools e.g. anatomy, physiology , pathology etc. Studing everything about an organ together makes a lot of sense.

[@brentkennis5683]

Any schema we use to understand human physiology and pathology is inherently flawed. That’s because schema’s are our attempt to categorize things that have no intrinsic organization. Human biology is the product of the semi-random process of evolution, and unfortunately has no truly deliberate organization. All that to say I agree that organ systems are outdated. It’s time to move on to a slightly less-incorrect model of understanding

[@Pakanahymni]

In the beginning of medical school I found that most things, like organ systems, are completely arbitrary. I think embryological origin could be used with categorizing organs, because it is pedagogically useful to be able to "bookend" a topic, even if the delineation is made up.

[@aremedyproject9569]

Well put! Love this channel.

[@in.stereo]

Awesome video with great insights - one of the reasons I chose to pursue general internal medicine - organ systems really don’t make sense to me. A system based approach also sidelines the speciality of psychiatry and the interplay between physical and mental health. Our physiology is the result of billions of years of evolution - could we approach our understanding of physiology from an evolutionary perspective?

[@magedabuldahab7481]

I hope internship starts with only geriatrics & reconditioning rehabilitation programs as in these 2 groups there are alot of comorbidities in their mild or non classic forms............in reality they are consumed with straight forward full blown picture cases which narrow their perspective......that's why you may find doctors in less equipped countries are willing to make a working diagnosis protocol rather than a rapid final diagnosis one as they face alot of general overlapping cases in their early career with few diagnostic tools that sharpen their decision making strategy

[@Brainologi]

He’s out of line…but he’s right

[@roland.j.ruttledge]

Great discussion, many thanks.

[@samratspeaks]

I think we should teach as SYMPTOMS. Symptoms should be the way to teach, I think.

[@KarimRodriguezz89]

It’s great to hear and learn from you once again Sir! Very informative! Accept greetings from Cameroon 🇨🇲

[@twistedtea7046]

my physical exam template: Vital signs: General: x rays: Ct scans: MRI: ultrasound: nuc med: some labs I guess:

[@oliver613]

The definition of organs and organ systems should be extended. Biophysically it should mean they have a similar way of celluar migration which is needed to maintain it's integrity and functions. But on the epigenetic level it would be hardly possible to describe this because everything resets in a short time. Even if it was possible there would be too many elements to list and this would not be beneficial to know. People who created pathway analysis literally spent thousands of hours to map out the patterns for activation. This information is only needed in our world. To treat diseases we need to understand what to remove from the pathways in tissue specific ways. This way HDAC meds will not be needed and the true price of medical procedures will be reduced to DNA sequencing costs.tj

[@matijaderetic3565]

Another example of limitations of categorical thinking.

[@rickshay4656]

Love how you think about the details in medicine and think about big shit. Great work :)

[@PraveenKumar-uk6nr]

❤️ from India

[@hyguruprep]

Agree - I have a KZbin channel preparing students for the USMLE Step 1 and Step 2 CK and have extensive experience in this realm. I appreciate you formalizing this conundrum as I have struggled with this throughout the years. For Step 1 tutoring and reviews - I strive to integrate across organ domains - i.e. talking about HMP shunt pathway when discussing normocytic, hemolytic anemias. This integration IMO is essential as concept linking between pathology and biochemistry drives retention. Unfortunately, this integration is missed by some of the popular resources! For Step 2 CK tutoring - I focus on clinical reasoning as stems such as next-best-step in management or what is the likely diagnosis force you to triage various problems discussed in vignettes (some of them being multi-organ system!). Using categorical thinking with organ systems as a general framework (as this organization is pervasive throughout the Med Ed system) with a focus on integration, specifically articulating areas where there is an organ system link or there is a related general principle tie in may be a small first step. Would love to discuss this more: [e-mail] or even collaborate! As a developing medical educator and current PICU fellow, I find your content enthralling & appreciate the impact you make!

[@StrongMed]

I'm not as familiar these days with test prep as I used to be, but your approach to it sounds great, and I agree that opportunities for integrating knowledge across domains is often missed by many resources out there! First Aid for Step 1 is probably the most overt and egregious example of this, but far from the only one. Unfortunately, I don't have much time these days for collaboration. I wish I did!

[@joelhall5124]

Any other members of the Rohin Francis Fan Club here?

[@katiehettinger7857]

Organ systems are a human construct to make the complex simple. You have outlined why continued adherence to chopping an integrated whole into part should be discontinued in favor to a wholistic view. So much is missed and patients poorly served, when Doctors specialize and deem systems out side their area of in-depth knowledge as practically irrelevant.

[@sunvavachi]

They are put into categories as there is so much to medicine and it is easier for us to study and teach that way. However I do not think its the organ separation causing an issue. I think there is not enough nutrition taught in medical schools in America to relate it to the systems also. If there was no system at all to relate to it would not work. The approach of teaching maybe can be changed. Approach to patient history. I did medical school in India and we are taught to take history as a whole. I think focusing on history is something lacking here I find as many patients are misdiagnosed in Americas and are undergoing tests unnecessarily when it really comes down to history, history, history! I do not like how here, different symptoms are put for different appointments. A lot of patients are not diagnosed well due to this time after time. It should be taken as a whole picture and that is what is missing! I tend to go holistic before jumping to anything but it has helped patients feel served and understood.

[@aasiyaabdalla601]

👍😊

[@tonym6920]

Let’s just say that each organ has its own distinct purpose yet they all work in concert with each other for the general well-being of the body. lol