The Art Of Listening

If you answer "yes" to one or a combination of the above questions, and you are not satisfied with your quality of health, you should strongly consider a comprehensive allergy evalution. The following is an account of one woman's experience with medical problems and a doctor who listened:

Of all the qualities I possess as a health care practitioner, I believe that my strongest asset is the ability and desire to listen to patients. It has always made sense to me that if I listen to a patient's medical history (without preformed bias) and then implement a medical plan based on the patient's personal health experience and my medical knowledge base, then I am more likely to see better results.

Over the course of my 15-year medical career as a primary care pediatrician and followed by my 11 years practicing allergy, my current opinions about the strengths and weaknesses of medicine have significantly evolved over time. I have found that the field of medicine functions better when medical problems are disease-oriented, objective, and medications and/or surgery can be utilized to solve the problems. This is because we are trained very well in the science of medicine starting from the first day of medical school.

This scientific priority results in doctors being more interested as well as more effective in treating infections, dealing with emergencies and critical care, surgery, and diseases with objective findings such as Diabetes Mellitus (with a positive blood sugar).

Conversely, I find that the biggest weakness as medicine is practiced is in the art of medicine. Specifically, doctors are not as effective at listening to the patient, using common sense and clinical judgment, and looking for the underlying reasons for problems. In summary, medicine works better for acute life and death problems and not nearly as well for quality of life/health issues.

The following patient history is an example of the importance of listening to patients.

Ada is a 39 year-old female who was initially seen by me in September 1996 with the chief complaints of fatigue, shortness of breath, muscle weakness, and double vision. Since 1983, Ada has had marked fatigue, especially for the year before her first visit with me. "Myasthenia-like Syndrome" started approximately 12 years ago with the onset of fatigue, weakness, double vision, and shortness of breath. Typically, Ada has been hospitalized two to four times per year, bedridden three months per year, required a cane for ambulation, and used oxygen as needed for shortness of breath. She believed that premenstrual syndrome, infections, hot and cold weather, and stress had triggered acute exacerbations of her medical condition.

This problem started approximately 14 years ago with childbirth, initially with the onset of fatigue and weakness followed by double vision and staggering gait. Initially, her physicians believed she had Multiple Sclerosis. After many comprehensive evaluations, the diagnosis changed to Myasthenia Gravis, but objective testing did not confirm this diagnosis. She has been fully evaluated by several Neurologists. Typically, Ada has been hospitalized if she is unable to breathe.

Her health status is complicated by a seizure disorder that started at age 18. Dilantin initially was beneficial but was discontinued because of pregnancy. Tegretol was utilized for one year and helped control Ada's seizures; however a number of adverse reactions developed and this medication was discontinued. Depakote was used for the past six years and has controlled the seizures fairly well.

Allergy symptoms include multiple nasal complaints for one year, hoarseness with difficulty swallowing, a long history of throat clearing, and increased mucous production in the morning. There is also a history of mild asthma, bloating for five years, and urinary frequency for over nine years.

Many M.D.'s have stated that Ada's health problems are entirely stress-related. Ada received psychotherapy from 1989 to 1993. During her most recent hospitalization in June of 1996 she was diagnosed with Chronic Fatigue Syndrome and Depression.

Based on Ada's history, I thought the most important recommendation was to restart the Dilantin, which had controlled seizures very well before her pregnancy, and to discontinue Depakote. The most pertinent feature of the history was the onset of the "Myasthenia-like syndrome" with childbirth. This coincided with the fact that Dilantin had been discontinued during the pregnancy.

Changing anti-seizure medications was discussed with Ada's family physician who preferred that the current Neurologist make a decision about switching from Depakote to Dilantin. The Neurologist refused. At that point I recommended that she look into a second opinion and gave her the name of an excellent internist. The internist I recommended agreed that Dilantin should be restarted and Depakote discontinued. After making the switch to Dilantin, Ada significantly improved. She had called me in late January 1997 to inform me that she was doing very well. In December 1997 she came into the office to tell me personally how well she was doing and to thank me personally for the significant improvement in her health.

Specifically, after starting Dilantin and discontinuing Depakote, Ada is now working, has been walking unassisted for the past year, has enjoyed excellent energy and strength, has had no seizures, no asthma or shortness of breath, and only occasional double vision. Prostigmine, a medication for Myasthenia Gravis is still being taken, and this helps droopy eyelids which is compatible with a Myasthenia Gravis-like diagnosis.

Ada's history is an excellent example of my really making a difference, primarily because I listened to her history and agreed with the patient that an adverse drug reaction can cause a serious medical problem.

Apparently, Ada does have a "Myasthenia-like" problem which is responding nicely to the appropriate medication, Prostigmine. However, many of her problems over the past 13 years (including the need for oxygen and frequent hospitalizations) appear to have been fully preventible if other physicians had merely listened to Ada.

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