Abstract
An unexpected treatment
I scanned my next patient’s electronic patient records. Back pain. Anxiety. Fibromyalgia. Multiple clinic letters. My heart sank as I called her from the waiting room and she hobbled in on her crutch. ‘Good morning. How can I help?’ I asked cheerfully, hoping she might just need a repeat prescription or a MED3. ‘It’s my back, doctor. It’s terrible. I can’t move. I don’t know why it’s so bad’. I asked the usual questions and I breathed a sigh of relief because she had no red flags. I was instead faced with the seemingly impossible task of helping her manage her pain, knowing that almost every analgesic and potentially useful specialist opinion had been exhausted already.
In the desperate hope that she might provide a magic solution, I asked, ‘What do you think we can do to help you?’ Her response was unexpected. ‘Well, doctor, I wonder if I should get a new dog. What do you think?’
Her dog had recently died, causing her unmanageable grief – a grief greater than some patients suffer in grieving for their relatives. As tears poured down her face I felt like I was in the middle of a very contrived medical school communication objective structured clinical examination (OSCE) …
Except this was real. She described how her dog had been her companion through multiple bereavements and significant life events. Her dog had been the only thing that made her feel safe living alone on a rough council estate. Walking her dog had been her way of maintaining her social and physical health. Her friends had been fellow dog-walkers on the estate, and together they went shopping after their walks and chatted while the dogs played. These daily walks kept her active and took her mind off her pain. After her dog died she had not gone out because she felt she no longer had a reason to do so. Her fellow dog walkers no longer called and she had lost her friendship circle. She had lost all purpose.
The loss of her dog had changed her life, and changed how she experienced her pain. She had unwittingly used the psychological and social support of her friends and the regular activity to manage her symptoms. It turned out that her dog had been her only effective analgesic.
In our training, we are taught to really listen to our patients and give them space to talk. We are told to look after patients holistically, and to consider their psychological and social circumstances in our data gathering. This can be difficult to do when you have just 10 minutes, the patient is complex and it appears that all avenues have been exhausted.
But this is not just to tick a box or to say that you have established their ‘ideas, concerns and expectations’. Sometimes, it really can be the key to finding their cure. We must remember that it is not asking the question that is important, but rather listening to the answer.
‘Yes’, I replied. ‘Think about getting another dog’.