I learned the value of listening to the patient

William Osler famously said (among other things):  “Listen to the patient. He is telling you the diagnosis.”

I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in  my skills and knowledge than was justified.  Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery to see the babies whose deliveries I had attended or assisted and always chatted with the parents about their new children.

One morning, in response to my question about how things were going, a young and first-time mother said that everything was fine but that it really hurt when her son nursed because of his tooth. I assured her that it was normal for the nursing to be uncomfortable in the beginning but that newborns do not have teeth. She insisted that her son did. One tooth. Left lower front. Sharp. I patiently (and condescendingly) explained that sometimes there were irregularities in the gum, and that there could be small cysts in the gum that were white (called Epstein’s pearls) that could look or feel like a tooth, but that true teeth did not erupt before birth, usually somewhere between 4 and 6 months.

She said, “Well, that’s fine, but my son has a tooth.” I said I would stop by the nursery later, check on the baby, and would get back to her about what it was that she mistakenly thought was a tooth.

After rounds and a teaching session, on my way to lunch, I stopped by the nursery. I asked about the Robinson baby,  mentioning that the mother kept insisting that her infant had a tooth. The nursery nurse tilted her head slightly, frowned at me, and asked if I had looked at the baby yet. “Nope,” I said. “Perhaps you should,” she said.

I washed my hands and got a flashlight, found the baby in his bassinet, and looked into his mouth. There it was, just as the mother had said. A tooth.

The nursery nurse tole me this was he second natal tooth she had seen in more than 30 years in the nursery.  I subsequently learned that natal teeth occur in approximately one out of 3,000 live births, that the tooth is usually only partially formed and has no secure roots, that they often cause the mother pain during nursing, and they may need to be removed (which is generally quite easy) to avoid accidental aspiration. More importantly, I learned the value of listening to the patient.

At the end of the day, before heading home, I stopped by the mother’s room. She was there with her husband and their baby. “You know that white thing you insisted is a tooth,” I asked. “Well, I checked him out and then did some research in the library. It took a while, but I know what it is. (I paused and made myself smile.)  You were right.  It’s a tooth. And here’s a copy of an article I found in the library, in case some other doctor doesn’t listen to you.”

Peter Elias is a family physician who blogs at his self-titled site, PeterEliasMD.

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