Trust Your Gut

A 65-year-old woman has normal mammograms, is on estrogen and is small breasted. She feels a pea in her breast. She has no relevant history and is otherwise healthy. Despite this sensation, her primary physician feels nothing and her mammogram of the breast is normal. The sensation persists. What should she do?

A 32-year-old medical student is previously well until the onset of headaches. The headaches are intermittent but daily and the young woman has never been affected by them before. She calls her mother who offers “free” medical advice. The student’s initial response is to “blow her mother off” and remonstrates or protests her advice as she, the patient, is a “scientist.” What does her mother do?

A 23-year-old woman in 1980 has been trying to get pregnant for three years without success. She and her husband have been together since they were 13 years old when they began dating. Their relationship is sound. They are frustrated and a bit down. The only other relevant medical history is some mild breast discharge. Her father fronts the down payment for an adoption, a rather healthy sum. He, the father, suggests she see a specialist before the “final” adoption installment payment is due. “For what reason?” she retorts. “I don’t know,” responds her father, “I sell trucks. But I do know that trucks are a lot better than they were 10 years ago and maybe there are some new discoveries out there to evaluate.” What happened?

All of these stories are fiction but based on factual situations that really occurred. In each case, the scenario imparts a deeper meaning to the attitudes of patients, doctors and families. Shared in these stories are persistence, independent thinking, arrogance, common sense and the willingness to question.

In case one, the patient was right. The patient is almost always right. However, sometimes the problem is obscure, hidden from view or the technology has not caught up with the disease. She and her husband decided to take the next step, see a surgeon, obtain a second opinion and get an MRI. However, a targeted ultrasound would have been another excellent choice. They persisted. No matter the outcome, the patient herself felt something new for an extended period of time. “The patient is almost always right.” Persistence and respectful questioning in healthcare are of incontrovertible value. The abnormality was a 2.5 mm cancer. She is disease free 15 years later.

In case two, the mother had become familiar with a recently discovered gene from reading her health articles. The mother discovered that she herself carried this new gene and that women who have it can develop clots or vein blockages if they smoke or take birth control pills. The medical student had started on birth control pills. When advised by her mother that the birth control pills were the cause of the new headaches, her daughter’s response was sanctimonious, arrogant and dismissive. How could my mother know more than I with my education? The birth control pills were withdrawn at the mother’s insistence and forceful persuasion. The headaches resolved, but it was only years later that the science or this gene became mainstream and the daughter accepted the cause and effect. Arrogance is a dangerous luxury.

In case three, which occurred in the early 1980s, the patient went to see a famous endocrinologist in New York City at the behest of her father. She had no medical background. The father possessed no formal education but was street smart, code for someone with common sense. The doctor said there is a new treatment for young women like her who have breast discharge. Women her age with such discharge can have a tiny tumor in their pituitary gland. It causes infertility and a new drug is just now available to treat it. There was no Google, internet or social media at the time. The doctor asked the patient to wait on the adoption. “It’s been three years,” the patient told her father. “We just can’t wait anymore. Can we please proceed with the adoption?” The father attends the follow-up appointment with the couple. Lila, the doctor, is convincing. She shows them the science. The father wisely refuses to complete the adoption until the couple gives the new therapy a try. The side effects of the drug are negligible. Pregnancy occurs for this couple in 60 days and then again a year later. They have two children. The father’s common sense allowed science to prevail.

Arrogance on the part of a patient, the doctor or in any field is a detriment to a solution. Listen to your doctor, but do not be afraid to respectfully question and persist when the answer is not forthcoming and does not fit with an assessment of your own health. Get another opinion when needed. Talk to your family. Trust your intuition. Use common sense.