I recently saw an orthopedic specialist who proposed to operate on my arthritic feet, which have been quite done in by my favorite pastime for thirty five years of jogging miles on pavement combined with the wearing of high heeled shoes to work every day to make my short self taller and thus more powerful. The surgeon described to me in detail a procedure designed to take the pressure off the big toe joint, and increase the mobility. When I got home, my husband had many questions such as “will this be done under general or local anesthesia?” and “will you need to wear special shoes afterwards?” and “how long before you can swim?” I stared at him slack jawed—I had not written down a list of questions before my visit, and I certainly couldn’t answer his. How quickly does the doctor become just like her patients who can’t remember what they have been told, despite the consultant’s serious attempt to educate and inform? Very quickly, it seems.
Some of my patients have taken the opposite approach to the consultation visit, presenting with dossiers full of notes and questions and treatises printed from questionable internet sites. This causes me to settle deep into the comfortable chair in my consultation room—I know that I’m in it for the long haul. I’ve grown to expect this at the first visit, but when the habit extends to the weekly “on treatment” visits, I know I am in trouble. The French have a saying for a particular type of patient—the patient that comes in with a long list of detailed handwritten notes each time he or she is seen. They call it “La maladie du petite feuille de papier”, or “the sickness of the little piece of paper.” The great Sir William Osler commented on this type of patient in his aphorism Number 309—”a patient with a written list of symptoms—neurasthenia.” Translate that to mean “anxiety disorder.” I recently had a breast cancer patient whose husband came with her for each on treatment visit. They had matching notebooks and matching pens, and they each studiously, meticulously and separately transcribed every word I that I uttered into their respective college ruled 100 page blue books. And when we were all done they asked me the questions that I had just painstaking answered, because neither of them had heard a word I had said—they were too busy writing!
There must be a happy medium in there somewhere. If you (or I) have specific questions about the risks, benefits and side effects of a proposed treatment, by all means, write them down and get them answered! But I do not need to see your journal of the quality, quantity, consistency and timing of your daily bowel movements. Really I don’t. Just give me the gist of it, please!