Wednesday, April 18, 2012

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 dermatitisWhen 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).

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