Care for the Patient, Not the Disease

Sir William Osler

The other day on the infectious diseases consult service I was reminded of the importance of understanding a patient's subjective experience of disease. 


After a patient with AIDS was admitted to the medical service with an acute gastrointestinal bleed, he repeatedly expressed his disapproval for the delay in receiving a medicated cream to treat his mild case of seborrheic dermatitis. When I suggested that he should worry more about taking the HIV medications and addressing the current GI bleed, he put things in perspective for me. 


"Doc, I may be a bit vain about my face, but when I am broken out" he said in a low voice, "people be asking me if I have that disease (HIV)."


The biopsychosocial impact of illness is undeniable. In this instance, I had failed to recognize his fear of stigma from even a mild case of seborrhea. I was properly humbled.


To quote Sir William Osler: Care more particularly for the individual patient than for the special features of the disease (address to the students of Albany Medical College, 1899).