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The Powerful and Underused Therapeutic

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I am fortunate to practice at a time when there are far more options to treat children with rheumatic diseases as compared to the days when I was in fellowship. The last 20 years have ushered in many new therapeutics that have been added to the armamentarium of a pediatric rheumatologist, similar to other disciplines of medicine. Many of these medications, such as the monoclonal biological medications or small molecule cytokine inhibitors, come with black box warnings about serious side effects such as infections or malignancies, need for prior authorization, parenteral administration, laboratory monitoring, and so on. Often, I still resort to the drugs that have been in use for a lot longer, such as cyclophosphamide, methotrexate, or mycophenolate. Of course, I often prescribe steroids for many indications as well. But an email I received from the mom of a teenager I saw many years ago is a reminder of another powerful therapeutic option in our arsenal: our words and time.

This mom tracked me to my current practice, about a decade after I had seen her daughter while practicing in a different state. As she was pondering her daughter’s upcoming graduation from college with honors, she couldn’t help but think of the important people in her daughter’s life who had really made a difference. And I was one of those people. Her daughter was a freshman in high school at the time she came to see me, and at the time she was experiencing chronic, unexplained pain throughout her body. I diagnosed her daughter with fibromyalgia. I didn’t prescribe her anything stronger than ibuprofen and lots of activity but her mother remembered that I spent time with her, educating her about exercise and staying active. I only saw her a couple of times, but years later, the mother felt my impact: I validated her daughter’s pain without coddling or excusing her from life.

Of all the cards, letters, and emails I have received from appreciative patients and families, this one stood out: unlike many of the children I follow for years, I had minimal interaction with her; I did not prescribe any of the magical drugs in my arsenal; she was not someone I saw in the hospital with a life-threatening disease. It struck me that what resonated with this patient was my validation of her pain, reassuring her that she did not have a chronic rheumatic condition, and my offer of ways to cope with her pain without resorting to pharmacological interventions. It was extremely gratifying to find out, years later, that my words and the time with her helped her begin the process of healing and that she used that experience to will herself to excel.

While I wish every patient encounter I have could end up with results like this, I concede that will not be the case. Most of us are rushed for time, having to see many patients amidst the distractions of calls and texts and interruptions, all while utilizing impersonal and complex EMRs. Furthermore, we often encounter skepticism, impatience, and disappointment of patients and family members who only hear that there is no easy fix for what ails them. Then there are others who are truly in need of the miracle drugs that practitioners of modern medicine can offer, which are specifically shown to treat their kind of malady. But in each of these instances, communicating honestly but with kindness, providing reassurance but with realistic expectations, and showing that we are listening and caring will make a difference and aid in the recovery.

I was touched to learn that my patient still mentions her visits with me often and expresses gratitude that she met up with, in her words, “a knowledgeable, caring doctor who set her feet on the right path in dealing with this often misunderstood and mistreated diagnosis.” As her daughter walked across the stage at her graduation, her mom thought of all the people who helped her in her achievement … and that included me.

So, the next time you prescribe a wonder drug, don’t forget to take the time to add a generous dose of words — you may find that it’s the best treatment of all. 

When have your words been the best medicine? Share your communication prescription in the comments.

Dr. Sampath Prahalad is a Professor of Pediatrics at Emory University and is the Chief of Pediatric Rheumatology at Children’s Healthcare of Atlanta. He is a physician, scientist, scholar, and mentor with a focus on juvenile arthritis, familial autoimmunity, and translational research. A devoted father and a husband, when he is not in the hospital, he loves to hike, travel, or try a new recipe on his instant pot. Dr. Prahalad is a 2021–2022 Doximity Op-Med Fellow.

All names and identifying information have been modified to protect patient privacy.

Image by Alphavector / Shutterstock

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