"My heart is blighted like grass, and withered, for I forget to eat my bread."
--A patient's prayer, Psalm 102
[None of the anecdotes in this post are descriptions of any specific patient. They are amalgams of many patients. Specific details have been distorted or invented to preserve anonymity.]
I diagnose and treat medical problems. I love doing it. Sometimes I make a big difference in someone's life. More often, I just reassure them that they're going to be OK. Or I give them advice about what they need to do to live healthier. But what I do has limits, and people frequently bring me problems that are well beyond my ken.
A business man comes to me for chest pain. He feels guilty because he has been misleading his business partner in a negotiation.
A wife has vague urinary symptoms after her affair of several years ends.
A middle aged man comes to me for insomnia. His endless work responsibilities have caused him to miss important events with his kids.
Of course, they each believe they may have a medical problem, so I examine them and order the appropriate tests. I rule out coronary disease, and infections, and hormonal problems. I call them with the good news. The tests are all normal. But they are not relieved. Their symptoms persist or even worsen.
I think I must be missing something. I send the business man to a cardiologist, the wife to a urologist, the father to a sleep specialist. More diagnostic tests are ordered. They are all normal. Good news, right? No. They are not reassured. Their symptoms continue and with every unrevealing test result they seem to give their symptoms more attention.
All primary care doctors see lots of these cases. These patients are seeking care in the wrong marketplace. They don't have a medical problem. Their conscience is bothering them. They're not sick; they're guilty. They do not require medicine. They seek absolution.
But I have no prescription for that, no advice for attaining forgiveness, for undoing wrong deeds. Perhaps I should send them to a psychologist. I ask some questions looking for symptoms of depression or anxiety disorder. I come up empty. They're mentally healthy, yet they are miserable.
What's the medical specialty that helps people who've done wrong? What's the service industry that undoes guilt? I'm no expert, but as far as I can tell, the only methodical approaches to this are in organized religions. My colleagues and friends who are psychologists and psychiatrists may object. But it seems to me that mental health professionals can only clarify the patient's goals and feelings, clarify if the ethical damage can be undone, and work through the feelings. That's a lot, but it doesn't strike me as what these patients are craving. They want to atone. Organized religions have a formula for that.
I'm not here to tell you to go to church. And I'm certainly not going to delve into theology or suggest that any religion's recipe for forgiveness is true in a fundamental or exclusive sense. I'm just suggesting that if you know you've done something wrong, and you feel terribly about it, maybe you don't need a doctor. Maybe you need a minister, a priest, or a rabbi.
Like I said, I love what I do. I can fix some medical problems, and I can help prevent others. I can help you live more days and make those days healthier. But there is more to life than that. Sometimes there is also wrongdoing, and guilt, and redemption. For that, I have no training. Forgive me.
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.