The wisdom of patients

My goodness, talking to patients can be instructive. I’m not referring to the old Osler adage “listen to the patient” (or “go to the bedside,” or whatever it was). No, I’m talking about hearing words of wisdom from them when they have actually come expecting the reverse.

Some recent exchanges with patients illustrate this. The first of these was during a visit by a brave woman, the mother of an autistic boy, who was seeking to become pregnant again. She was very aware of how much more stress she would be facing, but was nevertheless committed to raising the family she had envisaged having from the time she was young. Our discussion touched on multiple subjects, including the issue of vaccination and the discredited link between MMR immunizations and autism.

“I’m not crazy,” she said. “Of course my baby will be immunized. But I have some sympathy for the parents of autistic kids who support this nonsense.”

“Why?” I asked.

“Well,” she said, “I understand that my son’s condition was not a result of something I did. But if you were the parent of an autistic child, and you were exposed to the comments we get from other parents, wouldn’t you want to be told that his developing autism was not your fault? And wouldn’t you tend to support the people who understood your concern, and were trying to help you by showing that it was caused by something external? Even if some of their beliefs are a bit…out there?”

She had me. The antivaccination crowd (and I’m conflating a little here) may be annoying and ultimately dangerous, but the motivation for their perceptions is sometimes—to a degree—understandable. My patient’s experience meant that she understood that motivation better than I did.

A second patient also had a reproductive challenge. She had recently miscarried after spending a couple of years attempting to conceive. This would have been a distressing outcome for anybody, so I was surprised to see how upbeat she was during our first encounter after her loss. I tentatively told her that she was looking well.

“It was my grandmother who put this in perspective,” she said. “I was feeling shattered by what happened, and when my grandmother came to visit I guess I unloaded on her. She listened to my tale of woe, and she was sympathetic.”

“What did she say?” I asked.

“She told me about her first pregnancy, during the war,” she said. “She miscarried while at work, but felt that grieving an early pregnancy loss would have been selfish when the women around her were losing husbands and brothers. There was no time to feel sorry for a miscarriage. So she told herself ‘all experience is valuable,’ and moved on. And now I’ve adopted that as my personal code. Life is about moving forward.”

Amen to that, I thought.

The third patient, a younger woman with irregular menstrual cycles, had been trying for some time to conceive, but without success. She did not have a family physician, and had been seen and treated by a traditional Chinese medicine practitioner and a naturopath with no apparent results.

The explanations she had been given for her lack of success she found difficult to follow, but she understood from each practitioner that she had one or more misbehaving glands. Adrenal imbalance was mentioned, and she spent quite a bit of money on various forms of hormone treatment. After several months her patience (and her politeness) ran out and she presented to a walk-in clinic for another opinion. She was found to satisfy the criteria for a diagnosis of polycystic ovary syndrome and was referred for treatment with clomiphene. She conceived in her second cycle of treatment.

At her last visit she vented a little about alternative and unorthodox medicines.

“Do you know what you call alternative medicine that actually works?” she asked me.

“No,” I said. She smiled.

“Medicine,” she replied.

She was right. If it works, we use it, and if possible make it so readily available that patients can get direct access to it. As it turns out, her observation wasn’t original (I’ve since heard it from others), but it was an apt observation anyway.

These have been three small exchanges among many. It’s heartening to know that such wisdom is prevalent. Each of these women agreed to have me write their comments down, and they were all surprised to think that what they said was worth remembering. But I think it was.
—TCR