MEDICAL LESSONS FROM ANNIEL – II

LISTEN TO YOUR PATIENT, THEY WILL TELL YOU WHAT’S WRONG.   Medical Axiom

Soon after my daughter had transferred to the University of Chicago to be near a doctor who actually treated the conditions known as Chiari I and Pseudotumor Cerebri (PTC), I had occasion to approach him about some questionable behavior on the part of a resident in his program. The physician explained many things to me about the new students coming into medical schools. He said they were unused to real work and believed whatever they did had to be right because they had been reared by parents who taught them so. Students who had been raised on “self esteem” by their parents and teachers now had unions representing them, so they never had to take responsibility for themselves. He told me that minority students would accuse anyone who chastised them of racism. He said that we would look back on the 1990’s as the last of the “golden age” of American medicine. His admissions were stunning to me.

This doctor usually made rounds with only two or three residents or fellows accompanying him and they were pretty quiet then. One day he took all of his students on “grand rounds.” That meant that 10 to 15 people were crowded into my daughter’s room. I could not believe the student’s rude and insulting behavior, not just to my daughter but to their teaching physician, too. They talked and whispered to each other incessantly, giggled and laughed at jokes, and even shoved each other. The physician told me later that if he demanded they stop, someone would accuse him of abuse before the union.

I finally could not stand such behavior and said, “Dr. A, awhile ago you told me that the quality of the new residents you’re getting isn’t very good and they are hard to deal with. Were you telling the truth and do you still feel that way?” The residents stopped to listen to his answer. “Anniel,” he said, “It’s worse than I can tell you. They are so poorly educated that we almost have to start over. They don’t know how to work and don’t even seem to care. It’s a very sad situation.” He said some other unflattering things while the students watched with slack faces. I would have been crying had I been one of those students. I would not want anyone to think of me that way.

To my astonishment, when the physician turned again to my daughter the students went back to their former behavior. Remember, these were residents, which means they had already graduated from medical school. When they all left I told my daughter that I could not believe not one of them acted chastened at all. She laughed and said, “Oh mom, they don’t think he was talking about them.

There were so many times that these students needed to be failed in their studies and kicked out of medical school I can’t begin to write of them. But the university would have to deal with the unions. Some of these students had begun to mature when their rotations were over but most are somewhere out there now where I feel they are poor physicians and perhaps a threat to their patients.

There is one other aspect of the medical establishment that I feel needs addressing. No one, and I do mean no one, ever asks patients what they have learned about their illnesses. They never ask how treatment has changed them. It’s as though anything they learn is of no value.

When my thyroid was removed 43 years ago, it was a few years before I realized that the periods of ups and downs I had gone through for so long had been part of my illness. Just recently a doctor told me that what she referred to as “pulsatile thyroid disease” was very rare in the literature. Well, sure, most patients probably don’t figure it out and if they say anything the doctors don’t pay much attention. The “white blindness” I suffered the first summer I was in Alaska remained a mystery to me until my daughter had a thyroid storm and also went “white blind.” No one really cared about that either.

I bought a thyroid book when I knew my daughter had thyroid disease and could have added so much to what was said in it. None of the endocrinologists I have gone to have ever listened to what I could say, and when we tried to get a diagnosis on my daughter no one would listen to her symptoms. Let’s see, her hair was falling out in big hanks; she was freezing all the time, even in summer; she was losing weight and sleeping all the time. One endocrinologist told me to bring her back when she “starts having symptoms.” What did he think we had been saying for half an hour? Then he wrote in his report that the patient “denied” any family history of thyroid disease. We had told him about my grandmother, father, brother, aunts and myself. Had he been asleep or just not listening? Oh, I forgot: all patients lie to their doctors.

Dr. Hashimoto wrote the book on the thyroid in 1912, and I don’t think it’s been updated since. My daughter developed a newly identified (sort of) thyroid disease called Hashimoto’s Encephalitis a few years ago. After she nearly died and spent a few months going in and out of comas her thyroid was finally removed. When she went in to be checked by her endocrinologist in Anchorage he informed her that Hashimoto’s Encephalitis was not a “real” disease so to “shut up” about it. And, as he told us, all the other endocrinologists in Alaska agreed with him.

Are there good doctors out there? Of course there are. But they are only people like the rest of us and probably have their own bell curve.

Until medicine reaches another “golden age” we have to deal with what is, not what we wish was.

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