When doctors stopped listening to their patients

I was once attached to a gastroenterology clinic, when an immaculately dressed but apprehensive looking elderly lady in her 70s walked in for her appointment. The lady, C, was referred by her family doctor due to some unspecific bowel problems. The attending physician looked at her notes, mumbled some things to her in jargon-filled language, one of which was the word ‘Crohn’s’. C became alarmed, and asked the physician if it was something serious. He mumbled some more, and told her to forget about it until she’s had further tests. Within 10 minutes, the consultation was over, and C, was ushered out the door.

An hour later, I walked out to make my way to another part of the hospital when I spotted C sitting in the corner of the patients’ waiting area. She saw me and I walked towards her. She seemed deeply troubled and so I decided to stop and talk to her. It turned out that her husband had recently died and she was very lonely. They had met during the war in Italy; he was an Allied soldier who was not well-off and she was a Napolitan girl from a respected background. She described that it was ‘true love’ till the end, and how she turned her back on her home and her culture to be with him. She also revealed how she had waited for a long time for this consultation with anticipation, and that she had been worried about her own mortality since seeing her husband die. The mention of Crohn’s disease mortified her and became a further source of anxiety. The speed and tone of the consultation left her with even more emptiness than before.

What I learnt from this experience was that doctors often, by focusing on the symptoms and not the underlying cause of illness completely miss the mark on how to truly heal another human being. The gut-brain axis is a well-known connection, where stress results in worsening or even the appearance of symptoms. The symptoms are real, in that they are physiological and not ‘in the mind’. However, by zooming in on the physiological manifestation alone such as the case of C, will probably result in worsening of her symptoms due to more stress and anxiety. What this lady needed, besides being investigated further, is a referral to social services and psychological counseling. Perhaps her symptoms may even be cured without medications. She did not get what she needed, because no one was there to listen.

Yet, I cannot blame the doctor alone for his actions. The medical system is broken and the doctor is simply part of this broken system. It is a system that works well as long as we narrow its usefulness for treating specific physical symptoms but restrain our expectations on making us feel better. It is not a system that is focused on achieving optimal health, as defined by the World Health Organization to be ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity‘. Medical students, prior to being unleashed into the healthcare system should be made aware of the shortcomings of the current system. Medicine is not the magic pill to solving people’s health problems. They should be prepared for a world where unsatisfied patients will question them and ultimately leave their care for that conferred by homeopaths or acupuncturists who are better listeners with more time on their hands. Why would this be so surprising anyway?

There is an unfortunate tendency to portray patients who are doubtful or distrustful of the conventional healthcare system in a patronizing light. In paediatrics, I remember being taught that no one knows the child better than the parents. Yet today, medical professionals seem to be completely shocked by the ‘irrational’ behaviour of parents who claim that their child has had an adverse reaction from vaccination. Rather than listening to the parents’ concern (pre or post-vaccination), doctors are quick to judge parents as being irrational and quickly dismiss their fears or observations, which is paradoxically an emotional, rather than a rational approach to dissecting a problem. Shouldn’t we at least try to understand why these parents are concerned? Have they all suddenly gone ‘irrational’ for no apparent reason? This is when, in my opinion, the medical system has turned into some sort of a religious sect with a belief system that masquerades as ‘evidence-based medicine’, and anyone who even attempts to question the prevailing assumptions is quickly being labelled as a medical heretic. For parents, there is nothing more demeaning than earning the title ‘anti-vaxxer’ by the medical establishment.

 Are we entering the dark ages of medicine?