Saturday, 27 June 2009

Patients with bits of paper

Sir Richard Bayliss notes in his excellent autobiography (In sickness and health) a suggestion by Sir William Osler that, the doctor should beware the patient carrying 'un morceau de papier'. Osler suggests that patients who bring lists into the consultation are 'neurotic'.

I recall at medical school the caution from using 'always and never' so would not want to raise a concern about all patients bearing lists, but there are some days when Osler's words ring true.

Just yesterday I saw three patients with long lists all of whom are somewhat introspective and 'incurable' in the sense of bearing symptoms which are predominantly medically unexplained. I'm not sure that using the word neurotic is all that helpful since it carries such perjorative baggage (Indeed the American Diagnostic and Statistical Manual of Mental Disorders (DSM) has eliminated the category of Neurosis, reflecting the dawning recognition of psychoanalysis' status as art rather than science, and a decision by the editors to provide descriptions of behavior as opposed to hidden psychological mechanisms as diagnostic criteria).

Nonetheless what can we say about lists? I have to confess that I encourage my patients to take lists with them when they are facing a consultation with a speclialist, especially for the first time. So I wouldn't want to type cast. But still 'un morceau de papier' remains just one of many cues which experienced doctors use to form an assessment of a patient-just so long as it doesn't so prejudice and obsure the multpile other cues presented to them during any consultaion.
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