The story that I still can recall is about a patient sitting across from me and apologizing for telling me, “I know that this is not really a health concern for me.” It was neither pain nor a life-threatening illness that brought him to see me. It was just baldness. However, what he was feeling was absolutely real. He discussed the importance of not using mirrors. Not accepting invitations because he could not recognize himself anymore in photographs. More important to me than the alopecia were the parts of his identity that seemed to be lost with it.

In medicine, we learn early on the value of measurable indicators: blood pressures, lab results, imaging studies. There is, however, a whole other class of suffering that does not manifest itself through numbers. Hair loss exists in this area of grayness. It is frequently classified as elective, non-essential, and superficial. But for some patients, it represents more than that. It impacts self-confidence, social interactions, and possibly even how one interacts with others.

The definition of legitimate suffering

However, these patients feel compelled to downplay their condition. “I understand this isn’t serious.” “Other people have worse things going on.” “This doesn’t warrant my attention.” The reluctance speaks volumes about the standards set by our health care system regarding what is “legitimate.” We have established a dividing line between medically necessary and personally important, as though there is no room for overlap. The mental and emotional health of a patient does not occur independent from his physical presentation. The way he views himself is going to affect the manner in which he presents himself to the world. Disregarding this does not make it any less true; it merely means that it is going to go disregarded.

Finding balance in aesthetic medicine

It is especially critical when one considers the field of aesthetic medicine in which it is no longer just about treating the patient’s diseases, but his self-perception. An awkward contradiction emerges here. One must be careful not to medicalize what does not need to be. However, ignoring these issues entirely means missing out on legitimate pain and suffering. How can we find the balance between the two extremes? The key, I have discovered, lies not in determining if something is serious enough, but rather in hearing the patient’s complaint more clearly.

But when one is seeking help with hair loss, it is not really about hair; it is more than that. It is about confidence, about familiarity, about themselves in ways that they think have been lost. This does not mean that all demands must be met. It means that all concerns must be heard.

The evolution of modern health care

There is also an overall dialogue going on about the development of medicine. With medicine no longer merely focused on keeping us alive but now also improving our quality of life, we find ourselves faced more and more with conditions which do not fall easily into either the category of life-threatening or urgent. A case of hair loss would be an illustration but certainly not the sole example. The problem that faces clinicians does not lie in skill, but rather in discernment, the ability to know when to act, counsel, or redirect.

Above all else, the knowledge that sometimes you have to give things more serious consideration than is usual, even if they do not quite meet your preconceived ideas of what makes an illness. The patient sitting opposite me did not want vanity. He wanted to be him again. Perhaps this is something that medicine needs to consider more. For there are times when the seemingly little things carry much greater significance beneath. If we are truly going to attend to our patients, we must be able to see this.

Abdulaziz Balwi is a hair transplant surgeon in the United Kingdom.