AAMC Reporter: September 2000: Readers Respond

VOLUME 9, NUMBER 12

JORDAN J. COHEN, M.D., PRESIDENT

SEPTEMBER 2000

Readers Respond

What is the most valuable piece of medical wisdom you have learned from a patient?
While in private practice in California, I was taught how to care for a slowly dying child by Marti'n, a twin born with Hunter Syndrome, and his mother. When I first met the family, Marti'n's twin had already died in experimental bone marrow transplantation. Marti'n became increasingly ill and died at age 10. I received a note from his mother after his death that I have kept. She wrote: "Thank you for helping Marti'n to feel the best he could during his short stay on this planet. You did help. You took time with us and you listened, too. That was good doctoring where healing was beyond our reach." I credit this family and experience with helping me enhance my "doctoring" skills.

David A. Levine, M.D.
Clerkship Director and Assistant Clinical Professor Morehouse School of Medicine

A history and exam confirmed osteoarthritis in a patient who described thumb pain. Was I surprised when she cried after I gave her the diagnosis! Her primary care physician had suspected lupus because of a test result, and the patient had been afraid to tell me. The patient cried with relief, and I was able to reassure her. She taught me that seeking (and not assuming) a patient's actual concerns, even in "minor" medical problems, is vital to successful patient care.

Mary Ann S. Antonelli, M.D.
Professor, Department of Medicine
University of Hawaii
John A. Burns School of Medicine

I deal with patients with head and neck cancer. We do an operation which is lifesaving but often diminishes patients' quality of life. Even when I explain to patients that if they did not survive they would have no quality of life, they frequently tell me that higher quality of life even for a shorter time is better than survival with poor quality.

Horst R. Konrad, M.D.
Chairman, Otolaryngology Department
Southern Illinois University School of Medicine

First, if you give your patients the chance to tell you what's wrong with them, they will. Many doctors interrupt patients within 30 seconds of starting an interview. The original thoughts the patient was trying to convey are often lost. Second, the mind/body dichotomy is not a useful way to think about diseases and symptoms. "It's all in their/your head" is one of the most harmful things a doctor can say to or about a patient.

Richard Rathe, M.D.
University of Florida College of Medicine
The most valuable medical wisdom I have learned from a patient is to listen - and listen closely. Some patients and/or their parents have been able to predict a positive strep culture or urinary tract infection. The most illustrative example, though, is from parents of disabled children with chronic conditions such as cerebral palsy. In one incident, a nonverbal, retarded child who was post-op was to begin tube feedings, but the mother said she could tell her child was not ready. Within hours this child presented with bowel obstruction even though there were no clinical signs apparent when the mother refused the feedings.
Bruce P. Meyer, M.D.
Administrative Medical Director
Children's Hospital, Columbus, Ohio

When patients say that they are sick, chances are better than 90 percent that they are.

Ethan Fried
Associate Director of Medical Education
St. Luke's-Roosevelt Hospital Center New York City

To laugh is to heal, and we are all, at some point in time, patients and doctors.

Ben Bornsztein, Ph.D.
Director, Medical Education Research Department of Medicine Hennepin County Medical Center University of Minnesota

Next month's question: Should the number of U.S. medical students be increased?

Please send your responses (75 words or fewer) to rmuir@aamc.org or fax to (202) 828-1123. Responses must be received by September 14 for consideration, and may be edited for length and clarity. Also, please include your title, institution, and any academic degrees. Select answers will be printed in the September edition of the AAMC Reporter.