Making It Up

When I was a little girl of about 8 years, I complained a lot to my mom about ankle pain. Every night, she would put some salve on my ankles and massage them, and this always made me feel better. Naturally, she was concerned and took me to see my pediatrician.

I remember the questions the pediatrician asked me: Did my joints get swollen? Were they warm? Was it difficult to walk? Was I worse in the mornings? To all of those questions my answer was no, yet the pediatrician pronounced that I had juvenile rheumatoid arthritis. I was then placed on a fixed-dose combination of Maalox and aspirin.

I took home some brochures from the pediatrician’s office and borrowed some library books. From reading (with as much understanding as an 8-year-old possibly can have), I instinctively knew the diagnosis was inaccurate; after all, I had answered NO to all of her questions. But still, I was worried. How could I not be? Everything I read about the disease told me I would be crippled by the time I reached age 30.

When, after a few months, the medication hadn’t helped, and I did not develop any of her ominous suggestions (swelling, warmth, loss of function), I confirmed my suspicion that the pediatrician had simply made it up.

I suspect the pediatrician did what she thought was best, but it was a reckless decision. If she had been just a little bit more careful, if she had paid attention to my "no" answers instead of hearing what she wanted to, she would have figured out that I just wanted my mother’s attention – a textbook case of a secondary gain.

I would like to think that I am much more thoughtful in listening to my patients. I try to be as reasonably certain as possible before I give patients a diagnosis of a chronic potentially debilitating illness. Primum non nocere, after all. Sometimes, the kindest thing we can do is to not do anything at all.

Dr. Chan is a rheumatologist in private practice in Pawtucket, R.I.

When I was a little girl of about 8 years, I complained a lot to my mom about ankle pain. Every night, she would put some salve on my ankles and massage them, and this always made me feel better. Naturally, she was concerned and took me to see my pediatrician.

I remember the questions the pediatrician asked me: Did my joints get swollen? Were they warm? Was it difficult to walk? Was I worse in the mornings? To all of those questions my answer was no, yet the pediatrician pronounced that I had juvenile rheumatoid arthritis. I was then placed on a fixed-dose combination of Maalox and aspirin.

I took home some brochures from the pediatrician’s office and borrowed some library books. From reading (with as much understanding as an 8-year-old possibly can have), I instinctively knew the diagnosis was inaccurate; after all, I had answered NO to all of her questions. But still, I was worried. How could I not be? Everything I read about the disease told me I would be crippled by the time I reached age 30.

When, after a few months, the medication hadn’t helped, and I did not develop any of her ominous suggestions (swelling, warmth, loss of function), I confirmed my suspicion that the pediatrician had simply made it up.

I suspect the pediatrician did what she thought was best, but it was a reckless decision. If she had been just a little bit more careful, if she had paid attention to my "no" answers instead of hearing what she wanted to, she would have figured out that I just wanted my mother’s attention – a textbook case of a secondary gain.

I would like to think that I am much more thoughtful in listening to my patients. I try to be as reasonably certain as possible before I give patients a diagnosis of a chronic potentially debilitating illness. Primum non nocere, after all. Sometimes, the kindest thing we can do is to not do anything at all.

Dr. Chan is a rheumatologist in private practice in Pawtucket, R.I.

When I was a little girl of about 8 years, I complained a lot to my mom about ankle pain. Every night, she would put some salve on my ankles and massage them, and this always made me feel better. Naturally, she was concerned and took me to see my pediatrician.

I remember the questions the pediatrician asked me: Did my joints get swollen? Were they warm? Was it difficult to walk? Was I worse in the mornings? To all of those questions my answer was no, yet the pediatrician pronounced that I had juvenile rheumatoid arthritis. I was then placed on a fixed-dose combination of Maalox and aspirin.

I took home some brochures from the pediatrician’s office and borrowed some library books. From reading (with as much understanding as an 8-year-old possibly can have), I instinctively knew the diagnosis was inaccurate; after all, I had answered NO to all of her questions. But still, I was worried. How could I not be? Everything I read about the disease told me I would be crippled by the time I reached age 30.

When, after a few months, the medication hadn’t helped, and I did not develop any of her ominous suggestions (swelling, warmth, loss of function), I confirmed my suspicion that the pediatrician had simply made it up.

I suspect the pediatrician did what she thought was best, but it was a reckless decision. If she had been just a little bit more careful, if she had paid attention to my "no" answers instead of hearing what she wanted to, she would have figured out that I just wanted my mother’s attention – a textbook case of a secondary gain.

I would like to think that I am much more thoughtful in listening to my patients. I try to be as reasonably certain as possible before I give patients a diagnosis of a chronic potentially debilitating illness. Primum non nocere, after all. Sometimes, the kindest thing we can do is to not do anything at all.

Dr. Chan is a rheumatologist in private practice in Pawtucket, R.I.