Over to you
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The challenging patient
I was interested in the article on “The challenging patient” which appeared in the last issue of Casebook.
My consultant in Ashford in Middlesex was Alan Barham Carter, who once showed me an article he had written which he had called the “White-knuckle syndrome”. This consisted of white knuckles and four crescentic marks on the palm; however, these were exhibited not on the patient, but on the physician.
He then went on to say that when you saw this syndrome in yourself you should redouble your efforts to find an organic cause for the patient’s symptoms, because patients that irritate or upset you might still have something significantly wrong with them. However, your own emotions might get in the way of taking them seriously. This is essentially what you were saying in the article.
I have tried to find a copy of Dr Carter’s article but in vain. It must have been published before 1969/70, when I was his house physician.
Karl Fortes Mayer
Consultant Surgeon (UK).
PS I have been instructing my juniors about this syndrome for the last 30-plus years (Ed’s note: If anyone has information on, or a copy of, the above article by AB Carter then I would be very glad to pass it on.)
Tangled web
It would be childish to deny the web and internet as they are here to stay. The internet provides an incredible source of information to patient and doctor alike. However, any innovative system must have pros and cons and in its infancy experience teething troubles.
Undoubtedly the millions of websites available will have very good and very bad sites for many reasons – some for monetary gain, some due to ignorance, some to create mischief, etc. But, that said, some doctors need to be given a wake-up call that the internet is here to stay and the sooner they become conversant with it the better.
Patient education is very much part of modern medicine. But if the public are left to wander through the quagmire of the internet unassisted, it can only lead to chaos and consternation. Thus it is incumbent for any self-respecting doctor to be up to date with their knowledge of medicine as a whole so as not to be caught out. They must also be able to advise patients which websites are worthwhile and informative and which are dangerous.
I advise on “adders.org” in the UK and on “allexperts.com” in the USA on ADHD. Judging by the type of questions put to me on these internet sites, there is an urgent need to educate doctors about this condition, in my opinion. If this is correct, one may assume the same need might exist with many other medical conditions. However, my advice on the internet is always intended as a comment to be discussed with a patient’s own doctor.
Just an interesting fact about surfing the internet. It appears to be beneficial to the elderly in retaining their cognitive ability and delaying senility. Might that not benefit all doctors?
Dr WJ (Billy) Levin (South Africa)