A few months ago at my house, as the oil burner kicked on, black smoke started billowing out of the chimney and the smell of burning oil permeated the house. CRAP! What’s going on? Is my oil burner going to explode? Do I have a leak worthy of the BP engineers? Should I gather my valuables (i.e. dog, laptop and eyeglasses) and vacate? Will my vacation budget get blown on a new furnace? Will I even have a house left???
I make the early morning call to the emergency answering service. “Someone will call you back,” I’m told. I wait a while, thinking the worst, then get the call, “Someone will be with you today.” Several anxious hours later the repair man shows up. “Soot,” he says immediately, as he looks at the furnace, “Something’s clogged. I’ll have to sweep this out.” He didn’t seem too concerned, quickly got to work and all I heard was a lot of banging and vacuuming. Problem solved.
Now, what does this have to do with medicine?
I don’t know a thing about oil burners and heating systems but I know a lot about the human body. When I didn’t know what was wrong with my furnace, aside from alarming symptoms of oil smell and black smoke, I panicked. I had myself thinking the house was going to imminently explode. However, two seconds and the technician knew what to do. Similarly, when my patients come in with back pain or a swollen knee or fatigue and joint pain, in their minds their “house,” or body, is going to explode. Is it cancer? Are my bones collapsing? Will I be in a wheelchair by the time I’m 50? Will I be able to work? Will I die? Sometimes medical conditions take a while to diagnose, but sometimes I know in two seconds, “Oh, that’s just osteoarthritis of the knee,” just like my heating technician knew “Oh, that’s just a clog.” However, just like I did, my patient has other concerns.
One of the challenges of medicine, especially in the outpatient setting where time can often run short, is balancing the wants and needs of doctor and patient. It may only take a few minutes to inject an arthritic knee and in the doctor’s mind the problem is solved. However, the patient may still leave with fears about why he or she has this scary condition called “degenerative arthritis” and what that means in the scheme of his or her life. Always useful is this reminder that everyone has a backstory, an agenda, fears and expectations. Usually when rushed and stressed is the time we need to remember this the most.