Doctors get into trouble when they confusethe patient and their disease. We do thisoften, without thinking about it, partly asa sort of shorthand, and partly out of aneed to insulate ourselves. I am thinkingof the people who the housestaff describeas, “this 50 year old drug addict,” “thisunfortunate 37 year old schizophrenic” or“an elderly alcoholic.” I initially thoughtthat we do this only when the patient hasdisorders that are at the lower end of the“moral” scale we often use in thinkingof medical disorders, with rare somaticdiseases at the top, mental illness at thelower section and drug abusers at thevery bottom. But this turns out not to betrue. We often hear about, “60 year olddiabetics,” 25 year old leukemics,” “40year old vasculopaths,” in which diagnosesdo not register on the moral scorecard, soI’ve been thinking about what it meanswhen we speak of “a diabetic” rather than“a diabetic woman,” or “a leukemic,”rather than “a man with leukemia.” Whyshould we be insulating ourselves fromthese disorders but not when we speak ofa person with AIDS, or coronary arterydisease? When do we speak of a “dement”rather than a “demented person,” an “epileptic”rather than a person with epilepsy?I don’t know the answer and it troublesme. Labeling our patients by their diseasecertainly distances us from them but doesit diminish them? I tend to think it does,but I’m not sure. It shortens a clinicalpresentation by only a single word.One of the issues related to this isthe “interesting” case and the “great” case,measures of enthusiasm, usually by houseofficersand fellows, occasionally studentsor young attendings. “Come see this ‘greatcase.’”During my residency, my mentor-inchief,a deservedly famous neurologist remarked,after hearing a resident say, “I’vegot a great case to tell you about,” “Whena resident tells me he has a great case, it’snever good news for the patient.” I can’trecall whether I, too, talked about “greatcases” or not before that observation,but I’ve tried to distinguish “interesting”cases from “great cases,” and, in all cases,distinguish the problem from the patient.We all learn early on that the nicer thepatient, the worse the disorder.
展开▼
