Blog | Thursday, June 13, 2013

Treating the patient, not the disease


The team presented his story during pre-rounds. He had lived his life "cleanly," not smoking or drinking, eating in moderation. Recently he had a malignant disease present, and now had a new metastasis.

As a physician, we want to like all patients, but in fact, we have favorites. This man engendered respect and concern from the first time we entered his room. In trying to reconstruct our response, I feel at a loss. I cannot explain this feeling, one that I suspect all physicians have regularly. We just want to do a bit more for some patients. From the first time we met him, he knew that his prognosis was poor.

We worked on considering a treatment for the metastasis, but then another symptom occurred, and we discovered widespread metastases.

Each day when we visited his room, I girded myself for the conversation. Each day I left the room feeling a bit better. Each conversation could have been much more difficult had he and family not been so understanding and appreciative. We had the conversation about treating the patient and not the disease, because we could not defeat the disease. We made clear that we would not stop treating the patient.

Each day he encouraged me, not explicitly, but implicitly. Each day I sat at his bedside and held his hand. We made certain that all his symptoms were well controlled. We made certain that the family agreed with the patient's plan.

An important lesson occurs to most physicians over time. We can cure some diseases; we can slow the progression of some diseases; we can prevent the complications of some diseases, or at least delay those complications; but we should always remember that we are treating patients, not diseases. When we can no longer impact the disease, our responsibility does not change.

Patients, not diseases, are our responsibility. We must always remember that.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.