Fillers A memorable patient

Telling it how it is

BMJ 2004; 328 doi: (Published 15 April 2004) Cite this as: BMJ 2004;328:918
  1. Pippa Keech, general practitioner
  1. Forestside Practice, Marchwood, Southampton

    The patient, an elderly lady dressed only in her underwear and petticoat, stands mutely beside our lecturer as he tells us, third year medical students, about her disease. He leads her along the lecture platform, demonstrating her abnormal gait, and turns her away from us and gets her to flex her spine so that we can see how it curves abnormally.

    Move forward 15 years to an arthritis management day. This time our patient introduces herself as she sits among our small group of doctors. She is a “patient-partner,” trained by the drug company Pfizer to show us how to examine knees affected by rheumatoid arthritis—her knees. She does this confidently and competently, and, while doing so, she relays how these joint changes have affected her personally. As her severely rheumatoid hands are useless, an adequate range of movement in just one of her knees means that she can still get out of the chair without help. The joint effusion she shows us means that she has to work extra hard to maintain the necessary flexibility, but for her this is independence, so she works at it with dogged determination.

    A teenager who had to sell her beloved horse, a young adult unable to pursue her chosen career in nursing, a mother unable to hold or breast feed her baby—we hear how the disease has altered the course of her life utterly. Her role as a patient-partner is highly informative for me and empowering for her. Initially, I was shocked to hear a patient talking so knowledgeably about her condition, and then ashamed of that shock. My medical student training all those years ago is obviously more ingrained than I realised. While I embrace the idea of sharing care with a patient in a general practice setting, I am obviously just not used to the idea in a teaching setting.

    It has taken me 10 years of general practice to see patients as people and not as diseases. Patient-partners, while obviously better suited to teaching about some diseases than others, seem a good way of imbuing budding doctors with this knowledge a lot earlier in their careers.


    We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.

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