Verified by 
My first "patient" was a big and kindly man named Ronald Blake. I put "patient" in quotation marks because I met Mr. Blake when I was a first year medical student, with neither the skills nor experience to offer him any medical help whatsoever. In fact, Mr. Blake was enlisted to help me. He was the first patient I interviewed in a course designed to teach us novices how to take a medical history.
In a starched white coat, clutching a stiff new black doctor's bag emblazoned in gold with my monogram I entered Mr. Blake's room in the oncology ward, fully aware of my own ridiculousness. I wore a surgical mask because Mr. Blake, who had leukemia, was immunosuppressed. I looked and felt like a little girl playing doctor. But Mr. Blake put me at ease and even took me seriously. If I had not done this before he certainly had. Leukemia patients spend weeks at a time in the hospital and I was not the first student dispatched to his room to hear his story. And a sad story it was. I found myself tearing up behind the mask as he described the onset of his symptoms: an insidious fatigue that finally came to a crisis as he was coaching the Little League team on which his grandson played. The fall to the ground. The ambulance. The terrified grandson, whom Mr. Blake and his wife were raising because his mom--the Blakes‘ daughter--was on drugs.
A year later, after I had completed my pre-clinical courses as well as my first rotation on the medical wards, I returned to the oncology floor, this time for a clinical elective. By this time I had been initiated in the rites of the medical priesthood: I had worked 36 hour shifts, handled bodily fluids unfazed, heard the most intimate secrets and seen the most private parts of strangers.. My first night on call Mr. Blake arrived, requiring admission for a relapse of his leukemia. He smiled when I reminded him of our first meeting and he generously allowed, after I efficiently elicited the facts of his recent medical history, that I had learned a thing or two in the previous year.
But when I finally came home the next evening and pulled out my first clumsy account of Mr. Blake's illness, which I had , sentimentally, saved , I wondered what I had lost along with what I had gained in that year of medical training. My first year student's writing read more like a short story than a case report. It described how Mr. Blake had leaned heavily against the fence behind home plate, how he had laced his fingers tightly through the chain links, how he then noticed how just pale his fingers were...Totally useless stuff, medically. An embarrassment if it had ever actually appeared in his chart. And yet, these were the things he had chosen to tell me and, a quarter century later, these are the things--not the blood counts and bone marrow biopsy results I recorded dutifully as a more seasoned student--that I remember about him.
For many reasons--the short cutting of medical histories and physical examinations by ever more sophisticated laboratory and X-ray testing and the abbreviation of hospitalizations and visits to physicians due to economic pressures--the stories of medicine are giving way to the cases. The result is not merely that patients feel frustrated and misunderstood and that doctors enjoy practicing medicine less than they did years ago, though both are true. Diagnosis, treatment, and prognosis suffer as well. A recent study in Annals of Internal Medicine showed that patients who feel personally closer to their primary care doctors are more likely to get potentially life saving testing such as mammograms and cholesterol and blood sugar screens. The sharing of stories between patient and doctor, it turns out, is not just interesting fluff. It's good medicine.
In this blog I will be sharing with you stories from my internal medicine practice. I'll change the names and identifying characteristics of the patients (as I've done here with "Mr. Blake") but the interplay between story and case, the ways in which patients' (and doctors') experiences of illness affect the course and treatment of those illnesses, will be true.
