The great Dr. Sandy Templeton once asked his pathology class, “Why do people go to the doctor?” People came up with all sorts of responses, but to each he gave his best British, “No, no, no, no!” Then he would tell us, “They come to the doctor because they don’t feel well and they want you to make it better!”
So obvious. So simple. And yet, so complicated.
As physicians, we have a number of ways of helping patients, only some of which make the patient feel better. Primary and secondary prevention of disease don’t necessarily make people feel better in the short run, so they can be unsatisfying. And many ways of “not feeling well” aren’t easily fixed. People have complicated lives, lives full of stress, lives full of poor sleep, lives full of inactivity. There is no magic pill to make most people feel better.
Sure, sometimes we get lucky. I had a patient a couple of years ago who came in with the common complaints of fatigue, weight gain, etc., and as usual, I checked her thyroid—and not as usual, her thyroid was significantly low. Not long after I started her on thyroid hormone replacement, she felt considerably better.
Unfortunately, most people who feel generally unwell don’t have a simple physiologic problem such as a hormone deficiency. We can still help them by being good listeners and giving them good health advice, but that only goes so far.
In general, we fail to make everything all better all the time. This failure is accepted by most patients, as most people know that being human comes with various imperfections. But some people are not satisfied to know that feeling lousy can be normal. They will go from doctor to doctor, looking for “the answer.” Sometimes they find it. The third or fourth doctor may be the first one to finally diagnose the hypothyroidism, or celiac disease, or diabetes, but often the doctors say the same thing over and over—reduce your stress, eat better, exercise more. Take better care of yourself.
Which is, of course, not always possible.
Some people will continue to go from doctor to doctor until they finally land at the door of someone with all the answers. This person may have a different way of doing things, a way that somehow has escaped all the previous doctors. Often, a patient is just happy that someone finally listens, finally appears to understand their suffering.
Real doctors often give difficult news. Sometimes the answer to someone’s suffering is, “I’m so sorry. I’ll do whatever I can to help you through this.” Sometimes it’s tempting to give good news, whether or not it’s warranted. It can be very tempting to say to a patient, “You know, all of your troubles are due to a low selenium level, and if only your other doctors had checked it, you would have felt better by now. It’s a good thing you came to me. Here’s some selenium.”
But offering good news without evidence to back it up is self-serving and cruel. To elevate oneself as the only doctor with all the answers is dangerous, not least because you might start to believe it. And the moment you believe in your own infallibility is the moment you lose your way and put your patients at risk.