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Listen to the Patient

Some time ago, a patient was sent to me for a scope test.  This is hardly a newsworthy event since I do thousands of scope exams every year.  This patient had a known, benign narrowing at the lower portion of the esophagus, which is called a ring.  Years ago, another gastroenterologist stretched the ring which had been catching food on the way down. 

My assigned task was to examine the ring and determine if a stretching was necessary. 

This introduction of this case is the set up for the point I wish to make.  Too often, medical decisions are based on objective data without sufficient consideration of the patient.  Consider a few hypothetical examples.

An MRI of the back shows disc protrusions in the lumbar spine.  A surgeon reviews the study with the patient and explains the rationale for surgery.  However, a detailed review of the patient’s symptoms suggests that the back pain may not be caused by disc protrusion at all.  Indeed, many folks over certain age will have ‘disc disease’ without suffering any back pain.

An oncologist recommends intensifying treatment on an elderly based upon the results of a repeat PET scan.  The treatment is toxic and the patient feels well and cherishes his active life.  Has the expected negative effect on the patient’s quality of life been sufficiently considered?

A doctor advises laxatives as an abdominal x-ray showed stool in the large bowel.  However, the patient was not constipated.


Sir William Osler
Physician Role Model for Generations

My point is that objective data should be viewed in the context of the human patient and his story.  When this is done, there will be many examples when the objective data becomes less relevant.  As an example, when I performed the scope exam of the patient’s esophagus which began this post, I did identify the ring.  However, prior to the exam, he indicated that his swallowing was perfectly acceptable.  So, based on his own account, no stretching was necessary.

Listen to your patient; he is telling you the diagnosis.

Sir William Osler


Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox. Let the dialogue begin! And thanks for reading!

 

 

 

 

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