I knock on the door and open it to find a woman in her 50’s sitting in the chair next to the exam table. She’s polite as we exchange introductions, but there’s an anxiousness that quickly permeates her speech. I note the manilla folder and stack of CDs piled on top of it. I suspect this is a type of appointment I’ve had many times before.
She explains that her joints have hurt for over two years. She has difficulty working now. The fatigue is overpowering. Other medicines such as anti-inflammatories, acetaminophen, or even steroids, haven’t helped very much, or they’ve only worked for short amounts of time. She confirms my initial suspicion as she lists the others who she’s presented to: her primary care doctor, a pain specialist, an orthopaedist, and a new primary care doctor. Yet, her pain is unrelenting. Throughout my interview, she urges me to ‘read my chart, look at my lab tests!’ as she references the manilla folder and the CDs that hold radiology images.
Even as I review the past information and X-rays, after a few minutes, her sniffles give way to tears of helplessness. Her pain has become more and more unmanageable. I stop asking questions, ask to hold her hands, and I tell her, “It’s ok. It’s important for me to have this history. Thank you for bringing this information. Let me perform an exam, and we can go from there.” She agrees. She collects herself enough to bring me up to date with her present grievances, and she moves to the exam table where I find some swollen knuckles and a mildly warm knee. My assessment is that she may have inflammatory arthritis, but most likely not. I plan on ordering some additional lab tests and X-rays to complement the ones that have already been performed.
“Mrs. S, I suspect you have osteoarthritis, the type of arthritis that many people will get. It’s very common with age. But I can’t rule out that you have an arthritis from inflammation as well. So, we’ll run some additional tests and add some X-rays that I didn’t see as part of your past history. With this information I think we can make a diagnosis and discuss what to do next in a follow up.” In her expression, I can tell she understands me but that she’s also heard all of this before.
I add, “Mrs. S, you’re in the right place. Even if we can’t confirm something harmful or something that requires new medicines, when the workup is done, we’ll know who can help you best. We’ll get you the right care, in the right place.” With this concluding sentence, her eyes widen and she sits up straighter.
Undoubtedly, all physicians have experienced patient encounters like this one, wherever they happen to fall in the medical field. This anecdote is vague on the diagnostic details in order to highlight the general theme. I didn’t necessarily make the diagnosis in this visit or prove wrong other doctors who had seen the patient before me. I didn’t promise the patient a new diagnosis or a fancy treatment that would make her feel better.
What I did do was acknowledge the way she felt, and I offered my assistance to help her find her place among the massive web of healthcare. Oftentimes, in addition to having to deal with their disease symptoms, patients also have to deal with feeling lost in a massive and cold healthcare system. In medical school we are taught how to diagnose and treat countless maladies, but we’re often reminded that caring for the entire patient is the best way to heal someone.
We’re all crunched for time that we don’t have, performing tasks we feel are irrelevant to the patient-physician relationship. I don’t want to reproach colleagues who purportedly ‘don’t spend time with patients’. Instead, I want to ask fellow doctors to remind patients, and ourselves, that we’re on this journey together. And sometimes, the patient will feel best when they know they have someone who’s helping them find the right place.
Joseph LaConti is a rheumatologist in Miami, FL and a 2016–2017 Doximity Fellow