Why we shouldn’t pigeonhole patients into groups

I was scheduled to attend a medical director’s retreat the other day, but because of a horse emergency the day before, I had to stay home, so I offered to skip the retreat and see patients instead.

It would have been almost an entire day hearing about trauma informed care and the lifelong impact of adverse childhood events. As a primer, the conveners of the seminar emailed a “dear doctor” letter from a woman with a horrific childhood trauma history. One of the many vignettes in that letter was about her heart murmur, which disappeared when she started understanding and dealing with her trauma history.

I remember how, many years ago, a patient leaned forward in the exam room and blurted out at me: “You don’t know me!” I think many of my patients could say that, but hopefully most see me at least honestly trying.

Over my career, I have seen many diagnoses and many minorities grab public attention for a limited time, demand special treatment and claiming to be severely misunderstood by the medical establishment and by individual practitioners. Every few years there is another medical condition and one more misunderstood minority to attend webinars, conferences, and collaboratives about. Just when you feel you’ve integrated that one in your practice, another one comes along.

We have already, and I’m dating myself here, dealt with codependency, adult children of alcoholics, recovered memory, fibromyalgia, and bipolar illness, brushed by narcissistic mothers and alexithymia, struggled with bulimia and anorexia, not to mention cultural and religious minorities. We are right now scrambling to become politically correct with every form of transgenderism there is.

What’ll be next? I don’t know, but I do know this: These are not issues we can tackle one by one. There will always be new ones that never managed to get their fifteen minutes of fame. So, maybe some more of the airtime needs to be devoted to the fundamental fact that every patient we see comes to us with their own story, their own journey, their own wounds, dreams, hopes, fears, and demons.

We will never know everything there is to know about any fellow human being, and we need to be very careful when we see a general pattern in any one of our patients, not to pigeonhole them as being a classic example of whatever category they seem to fit into. Stereotyping is bad when we do it, and we should not steer our patients into stereotyping themselves.

We need to meet every fellow human being with an open mind, on their own terms, their own turf and in their own reality.

Sir William Osler said it a century ago: “The good physician treats the disease; the great physician treats the patient who has the disease.”

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Image credit: Shutterstock.com

View 2 Comments >

Get KevinMD's 5 most popular stories.