Testimony

I'm finally ready to go back to work," said Jim, a burly, middle-aged man in for his annual skin check. "I had bypass surgery 2 months ago.

"It's funny," he continued. "I didn't have any chest pain, just overwhelming fatigue. I used to be a firefighter, but now I go around the country lecturing on terrorism and security. When I was in California for a 3-day gig, I got too weak to stand, so I went home after a day.

"My doctor ran all kinds of tests and found no problems. Then he sent me to a cardiologist who examined me and did an ultrasound and a stress test. Nothing. My primary asked for a cardiac catheterization, but the cardiologist said no. 'That would be a waste of everyone's time and money,' the cardiologist told us, 'and there are risks,' she said. But my doctor insisted. The catheterization showed a serious blockage, which they repaired."

"And the fatigue?" I asked him.

"Gone," said Jim.

"What did the cardiologist say when she found the blockage?" I asked.

"Let's just say I had my records forwarded to another heart specialist," he replied.

When Jim left, I told my student that some cases are so interesting, you can't learn anything from them.

As if to confirm my observation, the very next day Mary walks in for her annual. "I hope this year is better healthwise," she said. "Last year was pretty bad."

"What happened?" I asked.

"Several things," said Mary, "but the worst was colon cancer."

"How did they discover that?" I asked her.

"I went in to my doctor and told him, 'I look like a cancer patient.'"

What?

"It's hard to put a finger on," she said. "I just didn't look right."

"Did you lose weight? Were you tired?"

"No, I felt fine," said Mary. "I just thought I looked like I had cancer. So I asked my doctor for a colonoscopy. He said, 'It's not time.' But I said I wanted one anyway. So he had it scheduled. Sure enough, they found cancer and took it out. I look much better now."

I wished Mary an uneventful year.

Not every tale has a moral. What can we learn from Jim's and Mary's? That we don't always get it right? We know that. That sometimes patients make observations and share hunches about their bodies worth paying attention to? Sure. That we should give in to demands for catheterizations and colonoscopies when there aren't any signs, symptoms, or clinical indications? Really?

It's interesting that both Jim and Mary told their tales in a doctor's office about a medical profession they apparently still trust; they could have concluded instead that the so-called experts don't know what they're talking about.

Imagine the same testimonies in a different setting. Say a lay group gathered to challenge the conventional medical establishment, one they see as blinded by limited perspective, deaf to what people know about their own bodies, insensitive to patients who advocate for themselves. Hearing these stories, wouldn't everybody in attendance nod in agreement and share their disapproval of what these stories so clearly seem to show, namely that doctors don't listen?

Personal anecdotes have great power, though of course they prove nothing even if told accurately. But what can we really do with them? Do we ever see patients who think they have cancer? Who report fleeting rashes and funny sensations that scare them? Should we biopsy them all, just in case? Run blood tests and x-rays?
Years ago one of my closest friends complained of itch with no rash. It turns out she had primary biliary cirrhosis and died 9 years later after her second liver transplant.

Since then I've seen more than a few itchy patients. Not one has had liver disease.
I am happy things turned out well for Jim and Mary and glad (though surprised) that their doctors followed through on their requests. I'm even more amazed that their insurers approved the requested tests. Imagine putting through this prior authorization: "I recommend this because the patient and I are sure it's the right thing." Now imagine the uproarious laughter in the insurer's office.

Stories are always worth listening to and thinking about. Jim's and Mary's certainly are. I just don't know if I learned anything useful from them.

I'm finally ready to go back to work," said Jim, a burly, middle-aged man in for his annual skin check. "I had bypass surgery 2 months ago.

"It's funny," he continued. "I didn't have any chest pain, just overwhelming fatigue. I used to be a firefighter, but now I go around the country lecturing on terrorism and security. When I was in California for a 3-day gig, I got too weak to stand, so I went home after a day.

"My doctor ran all kinds of tests and found no problems. Then he sent me to a cardiologist who examined me and did an ultrasound and a stress test. Nothing. My primary asked for a cardiac catheterization, but the cardiologist said no. 'That would be a waste of everyone's time and money,' the cardiologist told us, 'and there are risks,' she said. But my doctor insisted. The catheterization showed a serious blockage, which they repaired."

"And the fatigue?" I asked him.

"Gone," said Jim.

"What did the cardiologist say when she found the blockage?" I asked.

"Let's just say I had my records forwarded to another heart specialist," he replied.

When Jim left, I told my student that some cases are so interesting, you can't learn anything from them.

As if to confirm my observation, the very next day Mary walks in for her annual. "I hope this year is better healthwise," she said. "Last year was pretty bad."

"What happened?" I asked.

"Several things," said Mary, "but the worst was colon cancer."

"How did they discover that?" I asked her.

"I went in to my doctor and told him, 'I look like a cancer patient.'"

What?

"It's hard to put a finger on," she said. "I just didn't look right."

"Did you lose weight? Were you tired?"

"No, I felt fine," said Mary. "I just thought I looked like I had cancer. So I asked my doctor for a colonoscopy. He said, 'It's not time.' But I said I wanted one anyway. So he had it scheduled. Sure enough, they found cancer and took it out. I look much better now."

I wished Mary an uneventful year.

Not every tale has a moral. What can we learn from Jim's and Mary's? That we don't always get it right? We know that. That sometimes patients make observations and share hunches about their bodies worth paying attention to? Sure. That we should give in to demands for catheterizations and colonoscopies when there aren't any signs, symptoms, or clinical indications? Really?

It's interesting that both Jim and Mary told their tales in a doctor's office about a medical profession they apparently still trust; they could have concluded instead that the so-called experts don't know what they're talking about.

Imagine the same testimonies in a different setting. Say a lay group gathered to challenge the conventional medical establishment, one they see as blinded by limited perspective, deaf to what people know about their own bodies, insensitive to patients who advocate for themselves. Hearing these stories, wouldn't everybody in attendance nod in agreement and share their disapproval of what these stories so clearly seem to show, namely that doctors don't listen?

Personal anecdotes have great power, though of course they prove nothing even if told accurately. But what can we really do with them? Do we ever see patients who think they have cancer? Who report fleeting rashes and funny sensations that scare them? Should we biopsy them all, just in case? Run blood tests and x-rays?
Years ago one of my closest friends complained of itch with no rash. It turns out she had primary biliary cirrhosis and died 9 years later after her second liver transplant.

Since then I've seen more than a few itchy patients. Not one has had liver disease.
I am happy things turned out well for Jim and Mary and glad (though surprised) that their doctors followed through on their requests. I'm even more amazed that their insurers approved the requested tests. Imagine putting through this prior authorization: "I recommend this because the patient and I are sure it's the right thing." Now imagine the uproarious laughter in the insurer's office.

Stories are always worth listening to and thinking about. Jim's and Mary's certainly are. I just don't know if I learned anything useful from them.

I'm finally ready to go back to work," said Jim, a burly, middle-aged man in for his annual skin check. "I had bypass surgery 2 months ago.

"It's funny," he continued. "I didn't have any chest pain, just overwhelming fatigue. I used to be a firefighter, but now I go around the country lecturing on terrorism and security. When I was in California for a 3-day gig, I got too weak to stand, so I went home after a day.

"My doctor ran all kinds of tests and found no problems. Then he sent me to a cardiologist who examined me and did an ultrasound and a stress test. Nothing. My primary asked for a cardiac catheterization, but the cardiologist said no. 'That would be a waste of everyone's time and money,' the cardiologist told us, 'and there are risks,' she said. But my doctor insisted. The catheterization showed a serious blockage, which they repaired."

"And the fatigue?" I asked him.

"Gone," said Jim.

"What did the cardiologist say when she found the blockage?" I asked.

"Let's just say I had my records forwarded to another heart specialist," he replied.

When Jim left, I told my student that some cases are so interesting, you can't learn anything from them.

As if to confirm my observation, the very next day Mary walks in for her annual. "I hope this year is better healthwise," she said. "Last year was pretty bad."

"What happened?" I asked.

"Several things," said Mary, "but the worst was colon cancer."

"How did they discover that?" I asked her.

"I went in to my doctor and told him, 'I look like a cancer patient.'"

What?

"It's hard to put a finger on," she said. "I just didn't look right."

"Did you lose weight? Were you tired?"

"No, I felt fine," said Mary. "I just thought I looked like I had cancer. So I asked my doctor for a colonoscopy. He said, 'It's not time.' But I said I wanted one anyway. So he had it scheduled. Sure enough, they found cancer and took it out. I look much better now."

I wished Mary an uneventful year.

Not every tale has a moral. What can we learn from Jim's and Mary's? That we don't always get it right? We know that. That sometimes patients make observations and share hunches about their bodies worth paying attention to? Sure. That we should give in to demands for catheterizations and colonoscopies when there aren't any signs, symptoms, or clinical indications? Really?

It's interesting that both Jim and Mary told their tales in a doctor's office about a medical profession they apparently still trust; they could have concluded instead that the so-called experts don't know what they're talking about.

Imagine the same testimonies in a different setting. Say a lay group gathered to challenge the conventional medical establishment, one they see as blinded by limited perspective, deaf to what people know about their own bodies, insensitive to patients who advocate for themselves. Hearing these stories, wouldn't everybody in attendance nod in agreement and share their disapproval of what these stories so clearly seem to show, namely that doctors don't listen?

Personal anecdotes have great power, though of course they prove nothing even if told accurately. But what can we really do with them? Do we ever see patients who think they have cancer? Who report fleeting rashes and funny sensations that scare them? Should we biopsy them all, just in case? Run blood tests and x-rays?
Years ago one of my closest friends complained of itch with no rash. It turns out she had primary biliary cirrhosis and died 9 years later after her second liver transplant.

Since then I've seen more than a few itchy patients. Not one has had liver disease.
I am happy things turned out well for Jim and Mary and glad (though surprised) that their doctors followed through on their requests. I'm even more amazed that their insurers approved the requested tests. Imagine putting through this prior authorization: "I recommend this because the patient and I are sure it's the right thing." Now imagine the uproarious laughter in the insurer's office.

Stories are always worth listening to and thinking about. Jim's and Mary's certainly are. I just don't know if I learned anything useful from them.