Treating people not diseases

Our motto "Treating people, not diseases" was an inspiration from the film, "Patch Adams" where he told his peers that when you treat a disease, you lose, but when you treat the person, you will win all the time. Most of you would have seen this film where Patch Adams (Portrayed by Robin Williams) was this eccentric Doctor who would put on a clown's nose to entertain kids who were dying.

Most Doctors shy away from incurable patients because sometimes we feel powerless in those situations and sometimes it is because we do not want to be reminded of our own mortality. But Patch was different. He focussed on the patient, not the disease, so he felt that he could still do something for the patient even though there is nothing that can be done for the disease.

"Treating people, not diseases" is an mindset we adopt to remind ourselves that we are treating not just a headache, runny nose or a cough. It helps us remember that patients are real people who work to earn a living and have families who care for them and have joys and struggles in life.

I heard it said somewhere before that people are like onions. When you peel off the superficial layers, the deeper more significant problems emerges. This happens everyday in Family Practice. Let me illustrate with a typical situation:

A 25 year old lady comes to the clinic complaining of a headache. "Treating the disease" would be to make an accurate diagnosis and then to prescribe painkillers after making sure that the headache is not an indication of some serious event. That is treating a disease called Tension Headache. There is absolutely nothing wrong with that because the doctor has done what is expected of him both legally and morally.

When we try to treat the patient, the doctor takes the extra step to establish a relationship of trust whereby the outer layers of the onion can be peeled off to reveal the real underlying problem. I frequently have patients who present with seemingly innocent symptoms who are really suffering from depression or an inability to cope with the stresses of life. Some patients present with headache because they have not slept a wink, having to stay up the whole night looking after the newborn baby!

Many of our physical problems are a manifestation of psychiatric stressors. A condition like depression often masquarades as physical symptoms such as fatique, weight loss, menstrual changes, unusual sensations in the abdomen, chest or head, bodily aches and pain, dry mouth and difficulty breathing. The condition is common in stressed out Singaporeans but it is often not recognized by both the patient and her doctor. Unless the underlying depression is treated, the physical symptoms are likely to remain.

One of the most important roles of the Family Doctor is patient education, which is why I have started this blog. Many of the conditions are much better managed when the patient understands the rationale for treatment.

Asthma management is a very good example. Most parents who do not understand the rationale behind using Preventors often stop the medication prematurely. The parents who do understand the role of preventors are more compliant to give the medication for a longer period of time which result in the child being able to live without having to suffer the symptoms of asthma frequently. (For more info on Asthma, you may like to read the Asthma Series which have just been posted)

I will be the first to admit that "Treating people, not diseases" is sometimes difficult to do. I am far from perfect. (Some patients expect us to be superhuman and are surprised when a Doctor falls sick! If you prick us, do we not bleed?) Sometimes, after a long day, I get tired and it is much easier to just see the patient, prescribe some medication and send the patient home (Which is why it helps to close the clinic and take a nap in the afternoons) We can only say that we try our best.

If you have been our patient for a while, I hope this little article will help to explain our tagline to you and I hope you feel that we have tried to live up to the values that we espouse. If you have any thoughts or comments please feel free to express them by clicking the comments link at the end of the blog!