One of the toughest parts of treating patients is managing their expectations. We wish that everyone could enjoy a perfect recovery with complete healing, but the medical profession is imperfect and life is unfair. Some folks cruise by decade after decade without a scratch, while others sag under the weight of chronic illnesses.
Accepting reasonable expectations can change the game for patients and their families. If the patient’s expectations exceed what is possible, then the patient will never be satisfied and the dissatisfaction may assume a life of its own, which can torment with virulence equal to the disease. Second and third opinions may be sought, which usually lead to more testing and frustration. Learning to accept what is possible – though enormously challenging – creates a path toward leading a fuller and more satisfying life. While I haven’t been burdened with a chronic disease, I do personally understand that acceptance of a situation opens a path toward healing.
You have just experienced the joy and delight of a colonoscopy. The physician approaches you afterwards to inform you of the results. Which of the following hypothetical responses would you prefer?
We found a lesion in the large intestine that we are very concerned about. The biopsies will be available in 48 hours.
The colonoscopy was completely normal.
Of course, I am not entirely serious here. We all hope and pray for the second response. Yet, often, when I reassure patients that their colons are pristine, many react with frustration and disappointment. This usually occurs with patients who are suffering chronic abdominal pain and distress and are desperately seeking a concrete explanation for their symptoms. They enter the colonoscopy suite with stratospheric expectations that my scope will crack the code of what has stymied other physicians for years.
These expectations are fueled when other doctors they have seen advised that their pain is clearly coming from their stomach and intestines. So, when the CT scans and ultrasounds and blood tests and emergency room visits are all non-diagnostic, they want to believe that the light of the colonoscope will illuminate the diagnosis.
The light of my scope is really quite limited. It’s an accurate tool for many conditions, but is a clumsy diagnostician for chronic pain. Of course, the pain is real. But, our tools to identify its cause are often crude and inaccurate. In some instances, of course, there may be an occult diagnosis that the physician has overlooked. In most cases, however, the pain has no identifiable medical explanation.
At some point, a patient with chronic, unexplained pain must veer away from the quest to find its cause and onto the journey of living as full a life as possible with the condition. The choice may be ruling over the disease or being ruled by it.
Blogging about this is easy and comfortable, particularly when your humble scrivener is not suffering chronic pain. But I have seen patients who summon grit and moxie to stay in charge of their symptoms and their lives. They might not reach the end zone in one play or two, but they are steadily moving the ball downfield. Their efforts and successes are inspiring. I hope I have learned something from them.
Life is unfair and unpredictable. Which path do we choose when we are challenged?
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
