Last Word: Never underestimate a patient

December 19, 2003

Mr. W reminded me of why I became a doctor.

 

LAST WORD
Never underestimate a patient

By Terry J. True, MD

For one week, I had dreaded this day. I was told that Mr. W had made an appointment for a complete physical exam.

Six weeks earlier, I'd met Mr. W when he brought his wife to my clinic for her initial visit. The W's were in their 70s, and he still worked full time. Mrs. W had significant stasis dermatitis on both lower legs and arrived wearing Unna boots. The sores were weeping through the boots. She was quiet and pleasant. He was loud, obnoxious, and demanding. Mr. W answered every question I posed to Mrs. W before she could speak. I wondered if she was mute—but I knew the answer.

They were a study in contrast. Mrs. W was neatly attired, clean, and soft-spoken. Mr. W wore old, dirty overalls and his hands were stained with a week's worth of grease. She wore cologne while he wore the fragrance of the day's work.

Mr. W proclaimed loudly that he had a lot of questions he wanted answered. I responded softly, hoping my quietness would evoke a similar response. He didn't get it.

I changed Mrs. W's antibiotics and removed the soiled Unna boots. I instructed them on her care and made a one-week follow-up appointment.

She improved significantly over the next four weeks, but each visit was a replay of the first. Until last week—that's when he announced that he wanted me to be his new doctor. I feigned satisfaction with his choice. I dreaded his visit.

Today is the day.

The nurse told me he was ready. With a deep breath, I walked into the room to discover a clean, well-groomed, soft-spoken Mr. W. I quickly took control of the conversation, knowing that he was bound to erupt at any moment. But no—he succinctly answered each question and was delightful in his demeanor. I examined his well-scrubbed body and found every wrinkle to be spotless.

At the end of the exam he said, "Dr. True, the wife and I love you. You don't treat us like we're too dumb to understand. You talk to us like real people." With that, he jumped off the examining table and embraced me in a bear hug. I was speechless.

This taught me a lesson. Too often, I'd rather lecture than teach. Teaching takes time, effort, and investment. Lecturing is clean, cold, and factual. But today, Mr. W reminded me of why I became a doctor: my desire to teach people how to help themselves. Not to judge, not to reprimand, but to teach.

As I thought about that visit, I realized that whenever Mr. W was unkempt, it was because he had left work to bring Mrs. W to the clinic. When he was loud and demanding, he was trying to get information about his wife's condition and how to properly care for her. The day before her specialist's appointment, he drove to the hospital to find the office so that she wouldn't have to walk farther than necessary when they went together the next day. His entire being revolved around Mrs. W's well-being.

Mr. W taught me something, although he probably wasn't aware of it. Or maybe he was; he just didn't think I was too dumb to understand.

I look forward to his two-month follow-up.

 

The author is a family physician in Pelham, AL.

 

Terry True. Last Word: Never underestimate a patient. Medical Economics Dec. 19, 2003;80:92.