A Country Doctor Writes:

Dear Patient,

You and I have been working together for many years now, and we have had both triumphs and disappointments. You have looked to me for guidance and advice about many different medical issues, and sometimes also about life’s other challenges.

I hope I have been helpful most of the time, but I know there have been times when I have misled you. In the years since I came to this area, fresh out of residency, many things have changed – in medicine as in life in general.

I told you to put your first baby to sleep on her belly, because that was what medical science thought was best then. Now we believe that to have been bad advice, but Emily still grew up to be a healthy young woman, who now has a beautiful little girl of her own.

I told your husband to go on a low fat diet and to eat less salt to help manage his weight and high blood pressure. It seemed like such obvious, medically sound and commonsensical advice at the time, but it turned out to perhaps be the wrong thing to do. As I learned more, I told him to cut the carbohydrates and increase his intake of heart-healthy fats and that did seem to help his numbers. Eventually, Jim ended up on blood pressure and cholesterol pills as we both entered middle age. I am proud that the two older medications we started have stood the test of time and both proven themselves again and again to lower heart attack risk. I hope they will help Jim stay well and avoid his father’s fate.

I told your mother to consider estrogen replacement in her fifties, because it seemed to offer so many benefits beyond just relief of hot flashes. We will never know if that is why Sandra developed breast cancer. I am just grateful we caught it early and that she has stayed healthy and cancer free through her eightieth birthday.

I am grateful that your father never suffered any harm from Duract or Vioxx, the two arthritis medications I prescribed for him in the belief they were safer and more effective than ibuprofen. I had him stop taking them long before they were withdrawn from the market, because I followed the literature, but I know now I was too quick to prescribe them for him.

Your mother-in-law’s diabetes seemed difficult to control and she wanted to try the newest medications. I should have been more conservative, but thought Rezulin seemed reasonable to try. Just like your father’s arthritis medication, it was eventually taken off the market. When I shared my concerns about it, she accepted my suggestion to start insulin. Her blood sugars have been well controlled since then.

When we first met, I seemed to be the one who provided you with background information on your family’s medical issues, but now you have already read up on symptoms, diagnosis and treatment on the Internet before you see me. These days I feel more like an interpreter than a repository of medical information. I have enjoyed the transition, even if it has exposed how much more there is for all of us to know. I think I can help you look at different sources of information and help you weigh them against each other when they seem to be in conflict.

Over the years I have become more humble about my medical knowledge, even as I have learned many new things and gained more experience. When I first came to this country I had to quickly adapt to the relatively slight differences between medical practice in Sweden and in the US. I quickly realized there was more than one truth, more than one way of doing things. Now, after watching dozens of seemingly immutable truths shatter or fall in and out of fashion several times during my thirty years of practice, I know not to take any fact as absolutely certain.

I appreciate you staying with me as I have tried to apply what I have learned to your and my other patients’ benefit. As medical knowledge expands and treatment options multiply, I will do my very best to stay current without being swept away by unfounded enthusiasm for ideas and medications that may turn out to be short-lived fads.

I am not old yet, but my line of work is ancient. One of my medical school professors told my class we were there to learn how to learn. I never imagined then how many things I would learn, unlearn and relearn in the years to come.

You know by now I am not infallible, but I try very hard to do right by you. Thanks again for trusting me to be

Your

Country Doctor