Medicine as Detective Work

9-13-2025

By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

A physician at work, piecing together clues from patient stories, records, and test results—the true detective’s art of medicine.

Our history is the health story told.

With knowledge, physicians grow bold.

Wisdom hides in complexity unknown—

This is a record of how we’ve grown

----Dr. Howard Friedman M.D.

Thesis

Physicians are detectives. Every visit begins with gathering clues to tell the story of you.

Clue-gathering is not casual—it’s a disciplined process, and medicine has long relied on the S.O.A.P. format:

• S – Subjective: This is your story, told in your own words. Good physicians listen closely, capturing both “pertinent positives” (what is present) and “pertinent negatives” (what is not). The problem in today’s rushed healthcare system is that too often the story gets cut short.

• O – Objective: This is the evidence: the physical examination, lab results, imaging, and other measurable findings.

• A – Assessment: Here the physician interprets the clues, pulling them together into a diagnosis—a retelling of your story in medical language.

• P – Plan: The course of treatment, based on what is known, but also what remains uncertain. This is why medicine is as much an art as a science.

The Individual Puzzle

The first clue every good detective remembers: each of us is unique. Our immune networks blend genetics with lived experience. That complexity explains why one person thrives with a vaccine while another develops harm, or why autoimmune diseases blur into each other with overlapping symptoms that never fit neatly into one box.

Some conditions have no physical findings, no clear lab or imaging results. And yet the story is there. In my work writing Nexus Letters, I often encounter three such conditions: Chronic Fatigue, Fibromyalgia, and Tinnitus.

Chronic Fatigue – A Story of Restless Rest

Chronic Fatigue is closely tied to sleep disruption. Stage 4 deep sleep—the parasympathetic, restorative phase with slowed heart rate and lowered blood pressure—appears to be impaired. Anyone who has gone a night without rest knows the fog and exhaustion that follows. Chronic Fatigue is that feeling, stretched beyond six months, marked by brain fog, diminished stamina, and persistent fatigue. The patient’s story reveals the pattern.

Fibromyalgia – Patterns in Pain

Fibromyalgia is also rooted in the patient’s narrative, but here the physician must ask the right questions. The detective recognizes a constellation of physical complaints—widespread pain, tender points, sleep disturbance, cognitive fog—that together form a recognizable pattern. Again, it is the patient’s voice that unlocks the diagnosis.

Tinnitus – The Ringing Without Proof

Tinnitus is the phantom ringing of the auditory nerve after noise-induced injury. No lab test confirms it, no machine can measure it. Veterans who worked with jets, artillery, or heavy machinery know it well. Yet the VA sometimes grants service connection—and sometimes denies it—without transparent reasoning. For many veterans, this inconsistency is not just frustrating, it feels dismissive of their lived experience.

Medicine as Storytelling

In the end, medicine is detective work through storytelling. It requires time, patience, and curiosity. It means asking the right questions and listening for the details hidden between words.

Today’s healthcare often rushes patients in and out, trading compassion for efficiency. But real medicine is not a stopwatch exercise—it is the unfolding of your story, and the willingness of a physician to hear it fully.

That is the detective’s art

In scattered clues the truth will hide,

A whispered pain, a turning tide.

Not tests alone, but stories speak,

The fragile threads that healers seek.

When time is given, trust is found,

The art of care comes safe, profound.

—Dr. Howard Friedman, M.D.

—Dr. Howard Friedman MD

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

Frequently Asked Questions:

Q: Why is medicine often compared to detective work?

A: Because physicians rely on gathering and interpreting clues, much like detectives. The patient’s story, combined with physical findings, labs, and imaging, forms a trail of evidence that must be pieced together into a coherent diagnosis. The process requires curiosity, patience, and careful reasoning rather than rushing to conclusions.

Q: What role does storytelling play in the diagnostic process?

A: Storytelling is the foundation. The patient’s own words—the subjective portion of the S.O.A.P. note—often hold the key. Physicians who listen well capture not only what symptoms are present but also what is absent, which shapes the path toward understanding. Without this narrative, the objective data alone can mislead or remain incomplete.

Q: Why do some conditions remain difficult to diagnose?

A: Because not all conditions leave measurable footprints. Chronic Fatigue, Fibromyalgia, and Tinnitus often lack definitive labs or imaging. In these cases, diagnosis depends almost entirely on the patient’s account and the physician’s skill in recognizing patterns across scattered and subtle clues. These illnesses remind us that medicine is as much art as science