Feather in Our Physician's Cap but a Knife in the Patient's Heart.

This story has been published on various blogs including The Onion. If it is a true story (or even if it was a madeup scenario) it does represent a behavior that could be common to most all physicians. But it also provides a basis for caution.

ROCHESTER, MN—Dr. Erich Stellbrach, a general practitioner at the Mayo Clinic, could barely contain his exhilaration Monday upon discovering that patient Oliver Patterson, 54, has the extremely rare degenerative nerve disease Gertsmann-Straussler-Scheinker syndrome. "Mr. Patterson, I'm so sorry to tell you this, but you have—you're not going to believe it—spinocerebellar ataxia!" Stellbrach said, waving an x-ray of Patterson's spinal cord. "It afflicts only one in 2.9 million people!" Stellbrach recommended Patterson begin aggressive treatment to mitigate his impending brain dysfunction and onset of dementia, and made the patient promise to remain in his care.

Physicians are humans. We work hard. There is pleasure in our work by watching a patient recover from an illness. Unless we are a surgeon, we think and hope we had something to do with the recovery but often it is the patient's own body that heals itself. And we know that too. We often look forward to making a discovery in a patient that others have missed, especially if something constructive can be done for the patient. Finding the patient has a rare disorder is a thrill and something to be remembered thoughout our careers. But for the patient, the diagnosis may be no thrill that brings pleasantness or happiness, in fact it may bring anxiety and concern. To the patient "rare" means very unusual, that it hasn't been carefully studied, that noone knows anything about the cause or outcome and there hasn't been enough cases for a treatment to be devised.

The caution: What is a feather in our physician's cap can be a knife in the patient's heart. As physicians, in this moment of glory, we must contain our internal exuberance and remain aware what we say or do in the patient's presence. Our duty is to our patients, to serve them well and keep the professional glory to ourselves. ..Maurice.