This is a column about insensitivity in medicine.
And about caring.
They are two sides of the coin in the doctor-patient relationship, a jaded phrase that yet sums up the human contact, the rapport, the interplay of words and emotions that is a vital part of medical treatment.
Insensitivity. A Washington woman was given a prescription by her doctor. Once home, she had second thoughts. She wasn't sure the medication was necessary; she was worried about its effects and wanted to discuss them.
She phoned her doctor and said, "If you have a moment, I'd appreciate it. I'm a little bit concerned about the medication you wanted me to start on."
He just answered, "Don't take it, then. Goodbye!" and hung up.
Insensitivity. My mother, now 90, has changed doctors three or four times in the last 15 years or so, in each case for a sensible reason, twice to switch to a more advantageous health plan.
At a social occasion a few years ago she encountered the private-practice doctor she had left to join a plan more suited to her income. She wanted to say she was changing to another plan -- one he now belonged to -- and wanted to return to him. So she cordially said, "Hello, doctor, can I speak to you?"
He just said, "No, you're no longer my patient," and walked away.
Insensitivity. Because of a brief episode of confused memory, a man was sent to one of Boston's, and America's, leading hospitals for an EEG or brain-wave recording. He arrived, naturally apprehensive, fearing he might have some brain lesion that would affect his mind.
He got to the EEG department to be greeted by a vividly colored "Garfield the Cat" poster saying, "Welcome to the Funny Farm."
The EEG staff, needing a bit of humor, may have thought the poster amusing. The worried patient did not, and the greeting did not help when he was told, as the test began moments later, "Just relax."
Insensitivity. Dr. John Rosenberg of the University of California at San Francisco is the author of a chapter in "Medicine as a Human Experience" (University Park Press, Baltimore). As a medical student, he remembers, he watched a specialist put a tube-like instrument that can see inside the lungs down the throat of a man, 55, with a puzzling cough.
The specialist suddenly looked pleased. He had found an answer. "Well," he said, "it looks like you have cancer." And, Rosenberg says, he "left the room with a brisk stride."
Insensitivity. Dr. Judah Folkman of Boston's Children's Hospital told in a recent interview of his days as a young resident -- a doctor in training -- at the famous Massachusetts General Hospital. "We had just passed a set of closed curtains -- a man, 60, dying of cancer. The resident in charge just walked by and turned his thumb down.
"The next day the patient told me he saw that thumb, the shadow on his curtain. He became depressed and suicidal. In that one instant we had destroyed that patient's hope."
Another case. Insensitivity? Or just the wrong choice of words by a well-meaning doctor?
A University of Maryland professor tells how his mother, aged 91, fell in her sloping yard and twisted her knee. When she saw an orthopedist, he was not inclined to do much. "You know," he said, "you've got 100,000 miles on that knee."
"My other knee has 100,000 miles and it didn't go out," she said.
The orthopedist said he would try to give her a working knee. He did, and at 91 she's still active.
Every story here can be matched by stories of doctors caring, and stories of sensitivity to the aging or aged.
Joanne Sweeney of Darnestown, Md., tells how her mother, 88, was stricken one night recently while visiting. "I thought she'd had a heart attack or stroke. The next day I rented a wheelchair and took her to the doctor.
"When she got onto the examining table, I introduced her. Then I said to the doctor, trying to be cheerful, 'You haven't asked Mom how old she is.'
"He started to. He got as far as saying, 'How . . .' Then he stopped and said, 'What difference does it make?' "
Then he not only diagnosed the problem -- a pulmonary embolism or blood clot in the lung -- but also detected a thyroid deficiency and prescribed a medication that has made her "bright and alert, Mother once more," as her daughter puts it.
The insensitivities can often be explained. The woman whose doctor told her to forget her medication says, "He's often a bit testy, but I've had no other complaints." Anyone can be testy on a bad day.
The doctor my mother left -- a nurse later explained to her -- was angry and upset because he and his associates had been losing so many patients to the new health plans that were springing up.
"There are things we physicians are opaque to," admits Dr. Folkman, a man known to his patients and fellow physicians as one of the most caring persons they know.
"We just lose track of some things," he explains. "It's so hard just to take care of patients and not make mistakes every day. You know there are 25,000 diseases that have names, and you've got to pick the right one and not be wrong.
"So we're thinking about a thousand problems all day, and we don't think enough about the patients' anxieties."
"We must," he adds. The lapses, the insensitivities represent medicine's failures.
Next Week: Doctors who get sick -- what they learn, what they can teach us.