But Some Patients Would Rather Think 'Illness'


"Promote Wellness" -- that is what insurance companies want doctors to do. Basically, that means doctors should practice preventive medicine, teach their patients to stop smoking and drinking, to exercise and to eat nutritious foods.

But doctors should also encourage patients to think "wellness" rather than "illness." This is a Herculean task, and doctors run up against many brick walls when they attempt to plant the seeds of wellness in their patients' minds.

Not too long ago, I, an endocrinologist, saw patient Mrs. M in the hospital. An aura of frailty surrounded this woman. She looked younger than her stated age, which was 80. No wrinkles on her elfin face. She was slender, pretty and porcelain-like. Her husband was a tall and handsome 84-year-old gentleman who was attentive to her every need. He kept detailed notes about her symptoms, which were numerous. He meticulously noted down all her medications, and inquired after all their side effects. He doted on the woman he had been married to for nearly 60 years. Mrs. M clearly disdained him. A fragile queen, she sat on a pedestal, relishing her afflictions with Thespian intensity.

It was not easy for a doctor who entered her hospital room to leave within a reasonable time. If her heart was not fluttering, then her stomach was playing rock'n'roll. If her stomach was calm, then her head rumbled and groaned, depriving her of sleep.

For a decade or more she had been in and out of hospitals. There was nothing wrong with her heart, nothing wrong with her stomach, and her brain was in mint condition despite her age. Doctors had looked up and down her various orifices; they had probed her with X-rays, sound waves and other sophisticated waves. They had come up with nothing except osteoporosis of the bones and significantly high calcium levels. The suspected diagnosis was a benign tumor of one of her parathyroid glands. These glands, located in the neck, control the body's calcium balance.

After studying all her test reports, and after several lengthy conversations with the patient, I recommended surgery for the tumor. Surgery being the only definite cure, the patient was asked to see an experienced surgeon in the city, which she did after much dawdling and many anxiety attacks. At last she had the surgery. A benign tumor was removed from her parathyroid gland.

She came through the operation well. After some initial imbalance in her calcium levels, she stabilized and was normal for weeks. The only abnormality noted in the spectrum of all her lab tests had been corrected. Miracle of miracles, she admitted that she felt well.

Some weeks after her surgery, she visited me in my office, and at the end of her visit, she wondered how often she should continue to see me as an outpatient. "Maybe once a year, just so that I can keep an eye on your calcium," I replied.

She already had three doctors, one for her stomach, one for her heart and one for her general well-being. She didn't need me on top of all the others. When I explained this to her, Mrs. M gave me a wounded look. "I think I need to see you more often," she said. "In fact, I wish to see you more often."

I was not about to give up. "What would you be seeing me for?" I asked. "Your calcium levels are normal. You look great, you feel great. If something goes wrong, your other doctors will call me."

"All my other doctors see me once every three months." she said. "Why don't you do the same?"

"You're young and spry," I shot back, "You're in great shape. I wish I had your health. Truly, you don't need me, Mrs. M, not for a year at least."

"You don't like me, do you?" She was about to cry. "You think I'm a pest."

By this time I was flustered. "Not at all," I caught myself protesting, "I like you. Really, Mrs. M, you would be wasting time and money coming to see me. It's not necessary."

"It's my time," she declared, "and my money." (She is insured by Medicare).

I was almost quelled, but with the last breath I had in me, I surfaced. "You should think wellness, Mrs. M," I said, "You should stop thinking illness, and start thinking wellness. If you keep thinking wellness, you will continue to be well." When I finished my speech, I swelled with pride. I had persisted and I was sure I had won.

Then I heard her triumphant retort, "That is why I need you. No other doctor has been this honest with me. If I keep seeing you every three months, you will remind me to keep thinking wellness. It's the kind of encouragement I need." After that, I didn't surface for quite a while.

If the government turns Medicare over to Managed Care, that would curtail visits to doctors' offices, the only entertainment many bored and lonely senior citizens have. Watch Mrs. M and her ilk fight for their right to be entertained and diverted.

Usha Nellore, a physician, writes from Bel Air.

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