Commentary

By Lilli Jolgren Day

The surprise hit movie of this past 1998 holiday season was the story of a medical student who uses humor and compassion to treat the ails of his patients. While "Patch Adams" may have been considered an unlikely contender for the #1 spot by critics, the movie's success does not surprise me. My guess is that Hollywood's hierarchy has attributed its popularity to leading man Robin Williams, but I believe the success of this movie is quite simply its subject matter-a doctor who cares and shows it, who believes in the dignity of people whether sick or well and who treats his patients in a generous and loving way. The fact that the movie was based on a true story made it that much more appealing to a public that has been alienated and set adrift by a medical field that values science above humanness.
 
The discoveries and advances made in medicine over the past 100 years are extraordinary. The work of 19th century scientists such as Joseph Lister, Louis Pasteur, Robert Koch and Paul Ehrlich catapulted the understanding of germ theory in the 20th century forward helping to bring an end to terrible epidemics like cholera, diphtheria and smallpox. Advances in anesthesiology, infection control and microsurgical instruments have allowed surgical techniques and procedures to grow rapidly in both number and complexity. Charles Best and Frederick Banting discovered insulin in 1921 and treatment for diabetes became possible. The invention of the electron microscope in the late 1930s supported a better understanding of the biology of the virus, giving way to Jonas Salk's polio vaccine in 1955. Radiant energy and chemotherapy became important treatments in the fight against cancer during the 20th century and the medical specialty of oncology emerged, improving the chances of survival for cancer patients.
 
The list of medical innovations of this century is as endless as it is impressive, a fact that we can all be thankful for. Yet I believe that the same technology that our doctors now have available to them to help diagnose and treat disease has led them away from the art of medicine and seduced them into believing only in the science. The result of this progress, although noble in it's intentions, has succeeded in creating a generation of physicians with little confidence in their own innate ability to diagnose, treat and heal their patients and has led them to a adopt an agenda where the patients own words and suffering are undervalued in the process of diagnosing and treating illness.
 
Test results have become the sacred writ of the diagnostician and there is little doubt that CT, ESR, MRI, CBC, ECG, BUN, etc. can give a physician great insight into the pathology of an illness. But if a patient's account of symptoms does not match up precisely with the test results, or when test results are considered unremarkable or inconclusive, patients are often misdiagnosed or dismissed as malingers or hypochondriacs. The patient's personal story of illness and suffering is diminished and their quality of life is not given the same consideration and respect as are granted the test results.
 
People who suffer with chronic illnesses such as CFIDS, fibromyalgia, multiple sclerosis, inflammatory bowel disease, interstitial cystitis, endometriosis, lupus (and many others) are especially vulnerable to the torments of this mindset and know too well the frustration of attempting to gain a diagnosis and treatment strategy while plagued with a multitude of symptoms that are difficult to measure with medical tests.
 
A physician approaching a patient from a purely scientific viewpoint has the luxury of seeing things in black and white only. It is or it isn't. The patient, of course, does not have this luxury. A test result may tell a physician that the patient's pain is not caused by rheumatoid arthritis, but that fact does not change the reality for the patient, who is still experiencing the pain. Symptoms like sleep disturbance, fatigue, dizziness, intestinal distress, pain and cognitive problems are not only difficult to measure but they are invisible and subjective and as a result are often met with skepticism rather than compassion. Treating people with chronic illness is challenging and it is the exceptional doctor who understands that "difficult to treat" does not mean "difficult patient."
 
There is no reason to believe that the body of knowledge in the field of medicine will not continue its rapid growth, marching into the new millennium with continued speed and bringing with it many new and exciting discoveries and treatments for mankind's disease. Gene therapy, radiology procedures utilizing holography, telemedicine, anti-AIDS vaccine research, laser technology and minimally invasive surgical techniques are just a few examples of innovations and therapies that medical science is currently exploring and refining. I am not so foolish or naive as to believe that the use of a red rubber nose, a whoopee cushion and a book of knock-knock jokes are capable substitutes for these and other instruments of 21st century medical technology. However, as we come face to face with the year 2000, my hope for medicine and the men and women who practice it is simply this: that the patient's voice be heard above the roar of technology and that as science strives to heal the body, so the art of medicine will be remembered and called upon to care for the spirit.

Lilli Jolgren Day lives in Plymouth, Mich.