A Country Doctor Writes:

The other day I saw a woman who had transferred her care and then came back to me. There was a time in my life when that used to bristle me. Now I’m not threatened or insulted by such switches.

This patient was struggling with depression and anxiety and had, on her own initiative, tapered off her duloxetine. Some time after that she then destabilized and in that context transferred her care. Six months later she was back in my schedule.

Our “transfer of care” appointment took a while. I’m not sure by how much we exceeded our allotted time slot. But I plodded through our last several notes and read aloud to her my documentation of how the medicine had actually made her feel better, and how she had told me about her decision to taper off it. I listened as she described how her next provider went with the flow and prescribed bupropion, because she had “failed” duloxetine.

Her new medicine didn’t help her at all. I did spend a fair amount of time just letting her tell her own story. I then reviewed my notes aloud with her about how good she seemed to be feeling before her self directed taper. I also listed the things she did that made her feel better: car rides, friends, her therapist.

She cried for a while, sitting at the edge of her seat, then wiped her tears and blew her nose.

“You have felt better than this, I remember, and you do too”, I said.

She agreed to stop the bupropion and restart duloxetine in a low dose.

“I’d like to see you back next week to make sure things are working”, I said, and she agreed.

I knocked on the door, following my usual habit, of the same exam room exactly one week later. I wasn’t even halfway into the room when the serenity, for lack of a better word, struck me.

She was sitting in a relaxed position, wearing makeup, looking straight at me with a contented smile.

“I feel so much better. I’m sleeping at night. My appetite is back, and I don’t hurt everywhere anymore. This medicine is working for me”, she said. She took a deep breath and continued “but I think what did the most was that you took the time to listen. Those 45 minutes turned things around for me.”

I think so too, even though I’m sure we didn’t spend quite that much time together, but I didn’t say it out loud. But I do believe that, not infrequently, the doctor is the treatment, at least to a degree. Connection can be healing.

When the Doctor is the Treatment