Goodbye Jag: What a case-report will not tell. by Cornelis Kennedy Case reports (CRs) are considered an important tool in conveying information about unusual clinical cases. They serve an important purpose in sharing knowledge with colleagues about often unexpected outcomes. These clinical events are then chronologically presented, analyzed and at the end a conclusion is discussed. Often more is needed. Sometimes the information that is not presented in the CR provides insights that may have a bigger impact on us than the pure clinical data. Sometimes more needs to be said. Sometimes we find ourselves crying. It was late on a Wednesday morning when the resident called. My patient, Jag, … Continue reading
Ruth Tapp, a patient in the U.K., describes what it feels like for the patient to be the subject of bedside teaching. Here is the BMJ article: bmj.i6190.full This was a useful (and short) essay that will be of help to physicians, students, patients and their families. Some things have changed since 1920 — but not all!
By James Channing Shaw, M.D. Trust in doctors. It used to be absolute. If our sick patients improved, we were celebrated. When we failed, families praised us for trying. This arrangement was not right, but no doctor went to any great lengths to change the perception. About three decades ago, the pendulum swung. Now doctoring is frequently viewed as market share, self-promotion, unnecessary procedures and testing. It would seem that professionalism has become obsolete. Patients, too, have changed with the times. Many patients would like to have every test, expect their health problems to be cured, fixed painlessly, no disruption to social calendars, easy parking, and why can’t this cancer be … Continue reading
by Mr. B. In 2014, I won an insidious lottery: contracting Pityriasis Rubra Pilaris (PRP), a rare skin disease that one in 400,000 people get. After accepting this horrific verdict, I discovered I had a major choice. Do I take high-risk drugs in hope for a cure, after assuming a drug had initially caused my PRP? During the challenge of being alone in my struggle, I fortuitously discovered a special dermatologist. Dr. K respected my concerns about a conventional physician-patient relationship, and he followed my lead in selecting my treatment. The communication and trust we developed led to a slow, minimal treatment that after one year resulted in remission without … Continue reading
by Dr. K. In September of 2014, I saw Mr. B., a 68 years old man, with a wide-spread dermatitis that turned out to be pityriasis rubra pilaris (PRP). He was miserable with generalized red skin, scaling and painfully thickened palms and soles. My essay, “The Dao of the Red Man” describes our long and complicated therapeutic journey. Mr. B. relates his personal PRP struggle in “Skin Wars.” The interested reader will learn much from reading and comparing both Mr. B. and my narratives. They speak to PRP, the physician-patient dyad, and shared-decision making. The Dao of the Red Man Skin Wars – Mr. B Also see: Skin Wars by … Continue reading
Abstract: A young dermatologist discovers that treating the patient may entail more than just examining his skin. Sometimes, it is more important to treat the person than address the “chief complaint.” Keywords: doctor-patient relationship, aneurysm, skin exam, IT’s a busy morning at the clinic. My next patient is a 62-year-old man. After some small talk, he quickly turns to the point of his visit: evaluation of suspicious skin lesions on his back. “I’m only here because my wife’s concerned about these two spots. Otherwise, I feel fine.” He seems to be in a hurry, so I quickly examine his back and find only benign keratoses. When I offer to do … Continue reading
One morning, I pulled an empty chart from the rack on the examination room door: new patient, Ms. Judith Cornish, age forty-seven. I knocked twice and entered. “Good morning, I’m Dr. Shaw,” I flipped open the chart. “You are Ms. Cornish?” (I always used last names. It was formal, I know, but I preferred erring on the side of respect, not familiarity). I extended my hand. She sat, leaning forward in a chair, one very lean leg crossed over the other. “Good morning. Yes, I’m Judy,” she said in a husky voice. She shook my hand half-heartedly. In five seconds, I had processed a huge amount of diagnostic information: One, … Continue reading