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Teaching and Learning Moments

Dr. Demetriades is senior house officer, Department of Academic Surgery, St. Thomas' Hospital, London, United Kingdom.

This excerpt is from Dr. Demetriades' winning entry for the 1998 General Practice Essay Competition at the University of Cambridge School of Clinical Medicine.

It was Friday afternoon and the final day of my General Practice attachment. The week had gone quickly, and better than I had expected because I had the chance to see a variety of patients. I had seen handicapped patients, a young heroin addict, a suspected child molester, and even a manic-depressive man who dresses as a woman when manic. “After this last patient,” the doctor said, “we'll go for a beer. Shouldn't be too long.”

The patient was a middle-aged man, at least six foot three and as wide as the door. Although he had a history of mild asthma and diabetes, he looked fit enough to fight Evander Holyfield. He had come only for a renewal of his prescription, but seemed rather nervous. Sitting uneasily in his chair, he kept looking around the room. Maybe he was as anxious as I was to get out of there. When the doctor asked if he needed anything else, the patient said no too quickly and walked out of the room, but then hesitated. At the doctor's urging, he came back in, but didn't say anything. Speak, man, I thought to myself. It's Friday afternoon, for God's sake. “I've got severe diarrhoea,” he said. “I've had it for ten days and tried everything. It's driving me mad. Comes without warning. I've been carrying extra clothes, a towel, soap, just in case. Could you give me some…diapers?” He must have had to lower his ego quite a distance to actually come and ask for help, to share this mortifying problem. “Don't worry. I've something in mind which works wonders,” the doctor said reassuringly.

Strangely, I realized that this was by far the best consultation I had experienced during my undergraduate medical education, more didactic than any bizarre or rare case. This situation was not rare nor life-threatening that had led this man to seek help from the family practitioner, but it was a desperate situation. Doctors and students often fail to realize the unique position we are in, the special privilege we are given of knowing more about patients' personal lives than anyone else. This patient had not even told his wife, and they had been married for thirty-five years. He could not hide from her anymore, so he came to his doctor. I cannot easily describe the emotion I felt at that moment. It was the kind of feeling that comes only rarely to make one appreciate one's choice of profession and remind one of how much responsibility we carry, how much trust is put in our hands, and how much expectation is to be dealt with. I witnessed perhaps the simplest of cases with the deepest of meanings, and it came right at the moment when I thought I had seen enough to be satisfied with my training as a physician. Never. Maybe it is true: best things are left for last. That encounter has left me with something more than its mere practical value. It has given me back the original meaning of medicine.

© 2003 Association of American Medical Colleges