What lies beyond a diagnosis?
As far as I remember, medicine has been a pure science- the perfect biological process of how a human body works. The real joy of an internist lies with the perfect diagnosis. But my question is, how often do we go far beyond the diagnosis and the medications?
When we are dealing with a patient, we are dealing with 2 different elements- a biological process in the body and the psyche of the patient. If we ignore any one of them, the treatment is not going to work. Being the only doctor in my family, I am the first point of contact for a lot of in-family consults. I am basically practicing telemedicine to my whole extended family for years now. Recently, my uncle was sick with chronic abdominal pain. I ordered some tests and finally came to the conclusion that he might have chronic pancreatitis likely secondary to alcohol use. I disclosed my suspicion and was happy with my diagnosis and advised him to visit a GI specialist. As the days went by, every time I spoke to him he sounded quieter, mellowed down. Suddenly after a couple of days, he calls me, all worked up. His exact words were- ‘There’s excellent news, do you remember asking me to try the antacid gel? Yesterday I was preparing to go see a GI specialist but before doing that I just wanted to try the antacid gel, and voila, my pain disappeared!’ I am so relieved it’s not serious anymore. I was going through so much these last couple of days, I felt like it was the end, I have got a chronic condition that will eat me away. Now, I am so happy, its just gastritis.’
Suddenly I realized what he went through- I just focussed on his biological science but what about the mental trauma it caused? I never paid any heed to that. Is it because my textbooks never mentioned anything like- ‘ treat the psychological stress associated with the diagnosis of pancreatitis, amputation, pacemaker insertion’? My conscious mind wanted to tell him that it still doesn’t rule out my diagnosis. But I stopped myself and practiced the ‘art of medicine’ this time. I sounded happy for him and encouraged him to continue taking the adequate dose of antacid. At the end of the conversation, I softly brushed him with the idea of considering to visit the specialist if symptoms don’t completely go away. He still remained satisfied with my advice.
People will forget what you say, people will forget what you did but people will never forget how you make them feel – Maya Angelou.
Comments
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