A sharing by Darren Seah
Doctors at the frontline of contact and care are usually the ones to first face a spectrum of undefined and uncategorised symptoms. How we parse these symptoms may make a difference between whether we are effective in meeting the patient’s needs, or not.
Listening
Madam J was an elderly lady with well-controlled hypertension. By the time I met her, she had had consultations with multiple specialists, including a neurologist for headaches, a psychiatrist for sleep problems, a gastroenterologist for dyspepsia, and an otolaryngologist for episodes of vertigo.
In my initial consultation with her, she once again presented with various symptoms without any objective signs, and an absence of a clear diagnosis for any of her complaints.
As I explored her social background and living arrangement, it was evident that she was lonely. I listened to her for twenty minutes as she went from one story to another, mostly unrelated to any medical issue.
At the end of the consultation, Madam J did not request any medications and I did not offer to prescribe any. Instead, we agreed on a review visit in two months.
Commentary
The drawing depicts a nameless patient who is identified only by a number. He carries a box with a lock. The box holds the patient’s true problem, packed up in layers of his ideas, concerns, and expectations. The doctor needs to choose the correct key, or keys, with which to unlock the box and to understand his patient.
Which key holds the secret to this deep understanding? The choice ranges from easy cures to the potentially toxic. One can organise a battery of tests and suggest a range of therapeutic options. And yet perhaps one additional key is missing. What is also needed is a listening ear, empathetic responses, and genuine compassion.
A good clinical consultation can be more than a process towards a diagnosis and treatment plan. The consultation itself can be a therapeutic process by which the patient develops a better understanding of his illness. In the process, the box is unlocked for both the patient and his doctor.
——Dr Darren Seah
Dr Darren Seah is a family physician with an interest in cardiovascular medicine and endocrinology. He is also the program director of a Family Medicine residency.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
