Doctor, listen to your patient

Sir William Osler

“Listen to your patient, he is telling you the diagnosis.”

Those are the words of William Osler (1849-1919) often called the Father of Modern Medicine for his contributions to the development of medical education. I first heard them from the chief of surgery at the beginning of my internship. It is almost always true, the patient is almost always telling you the diagnosis, but listening is harder than you might think. That’s because most patients are simultaneously offering a lot of extraneous information, and some patients are not completely honest in the information they offer.

In fact, the patients who are deliberately deceptive seem to have an outsize influence on the practice of medicine. During internship and residency, young doctors are repeatedly fooled, and therefore embarrassed, by patients. Drug addicts are notorious for presenting themselves as model citizens with serious pain problems. After several episodes of unwittingly giving an addict a fix, or a prescription for drugs that will be sold, young doctors begin to listen to a patients’ stories with increasing cynicism. The subtext for many physicians, consciously or unconsciously, is that they must be convinced that the patient is telling the truth.

I suspect that this problem is at the root of many errors of diagnosis. It is obviously much more difficult to diagnose a problem if the patient has an unusually constellation of symptoms. However, the biggest stumbling block is that the doctor believes that if the symptoms make no sense, the patient must be telling the story wrong, or have some other reason for the symptoms such as depression or medication seeking behavior.

That’s the biggest advantage I have when approached by a friend or relative for help with a difficult medical problem. It can sometimes be much easier for me to figure out the diagnosis than it is for the doctor they are seeing. That’s because I start out by believing them, because I know them, and I don’t waste valuable time pondering whether they are honest or reliable reporters of their symptoms.

Recently a friend called me about unusual symptoms his father-in-law was having. The relationship between our families has extended through several generations, and I knew his father-in-law well. He is a distinguished emeritus professor with a piercing intellect and ongoing curiosity and engagement with the academic world. As he approached and passed his 80th birthday, he was afflicted with slowly progressive muscle weakness. He became wheelchair bound and continued to weaken even further. Ultimately, he was barely able to muster the energy to move.

His impressive team of doctors was stymied by the symptoms and took the easy road. They concluded that he was weak because he was old. There was nothing to be done.

His son-in-law called because his children were convinced that something was going on besides normal aging, but did not know what tests and investigations to insist upon. That’s where my advantage came in. I listened to his story and believed him because I knew him and I knew them. I started from the premise that the story must be true and went from there.

Whenever an elderly person develops a global symptom like fatigue or confusion, the first place to look is at their medications. As people become older, they are put on ever increasing numbers of medications to treat various unrelated ills. Often, some of those medications will interact to produce unusual side effects. In addition, as people age, the ability of the kidneys or liver to break down the medication and remove it from the body diminishes. Because the medication stays in the body longer, it has a chance to build up to toxic amounts. A dose of medication that was conservative 10 years before may have slowly become an overdose.

Since whole body muscle weakness is certainly a global symptom, I asked for a list of his medications, and then I went down the list looking for generalized muscle weakness as a rare side effect. I hit the jackpot almost immediately. Pravachol, a statin (cholesterol lowering drug) he had been taking for decades, is known to cause generalized muscle weakness in rare circumstances by damaging muscle cells. The chance of this unusual side effect is increased in the elderly and is further increased in people with diminished kidney function, which happened to be present in this case as well.

I was so excited that I called my friend right away to tell him. I promised to do further research later in the evening, but in the meantime, he started investigating the rest of the list for unusual interactions between drugs. Sure enough, he found that another medication on the list was known to interact with Pravachol to increase the risk of generalized muscle weakness.

We had the diagnosis: Pravachol induced myopathy exacerbated by age, decreased kidney function and interaction with another drug. My friend called his father-in-law’s doctors first thing the next morning, and the Pravachol was discontinued. Recovery began almost immediately. He now feels better than he has in years and has begun to walk again.

The professor called me recently to express his gratitude. He thought I had made an incredible diagnosis. Frankly, I am a bit embarrassed. I didn’t really diagnose anything. He had been recounting the symptoms of statin induced myopathy in detail for months, if not years. All I did was listen.


  1. microsoft exchange online price - July 23, 2021

    … [Trackback]

    […] Read More here to that Topic: […]

  2. best sex toys - July 23, 2021

    best sex toys

    […]please check out the internet sites we comply with, including this 1, as it represents our picks through the web[…]

  3. how to lose belly fat naturally - July 18, 2021

    how to lose belly fat naturally

    […]please visit the web sites we comply with, such as this one, as it represents our picks through the web[…]

  4. bulk 30 30 ammo - July 16, 2021

    bulk 30 30 ammo

    […]the time to study or take a look at the content or web sites we have linked to below the[…]

  5. Hedgehog For Sale - July 14, 2021

    Hedgehog For Sale

  6. Study Table - July 14, 2021

    Study Table

    […]just beneath, are numerous absolutely not associated websites to ours, nonetheless, they may be certainly really worth going over[…]

  7. Google - July 13, 2021


    Very couple of web sites that occur to become detailed beneath, from our point of view are undoubtedly effectively really worth checking out.

  8. escort bayan istanbul - July 13, 2021

    escort bayan istanbul



    […]very couple of internet websites that come about to be in depth beneath, from our point of view are undoubtedly properly worth checking out[…]

  10. - July 8, 2021

    […]The info mentioned in the article are some of the ideal accessible […]

  11. white mousse concentrates - July 6, 2021

    white mousse concentrates

    […]very few websites that take place to become detailed beneath, from our point of view are undoubtedly nicely worth checking out[…]

  12. kimber k6s dcr for sale - July 6, 2021

    kimber k6s dcr for sale

    […]here are some links to sites that we link to simply because we believe they’re worth visiting[…]

  13. weed near me - July 5, 2021

    weed near me

    […]we came across a cool web page that you just may appreciate. Take a look for those who want[…]

  14. Seattle Weekly - July 5, 2021

    Seattle Weekly

    […]usually posts some very intriguing stuff like this. If you are new to this site[…]

  15. buy weed - July 5, 2021

    buy weed

    […]Here are some of the web pages we suggest for our visitors[…]

  16. pocket vibrator - July 3, 2021

    pocket vibrator

    […]the time to read or visit the material or websites we have linked to below the[…]

  17. male masturbator review - July 3, 2021

    male masturbator review

  18. Delta 8 gummies - June 30, 2021

    Delta 8 gummies

    […]Here is an excellent Weblog You may Uncover Intriguing that we Encourage You[…]

  19. marijuana dispensaries near me - June 29, 2021

    marijuana dispensaries near me

    […]we came across a cool site that you simply may appreciate. Take a look when you want[…]

  20. delta 8 products - June 29, 2021

    delta 8 products

    […]we came across a cool internet site that you just could get pleasure from. Take a look should you want[…]

  21. Delta 8 - June 29, 2021

    Delta 8

    […]Sites of interest we have a link to[…]

  22. microsoft exchange online plan 3 - June 26, 2021

    … [Trackback]

    […] Info on that Topic: […]

  23. Google - June 22, 2021


    Please stop by the web pages we follow, like this one, as it represents our picks from the web.

  24. nike air max cheap - February 12, 2015

    nike air max cheap

    Also i just like browsing on with thesixtyone. net it has a splendid graphical enviroment, wonderful tracks coming from breakin by means of music artists and a nice social network.

  25. nike tn requin - February 12, 2015

    nike tn requin

    I stumbled across the same problem whenever initially I got trying to exercise why stuff ended up taking too long in order to obtain with this assistance. I put often the marketing tabs showing in the Microsoft windows Taskmanager and pointed out that…

  26. nike air max pas cher - February 12, 2015

    nike air max pas cher

    Seems awesome. They also have really performed their particular focus on this to make design and style a priority. Is it doesn’t very first time I really could truly find personally utilizing House windows again. Operating system, within the other-han…

  27. moncler pas cher - February 12, 2015

    moncler pas cher

    We provided picture from your vault in the apple iphone, the person obtaining that own apple iphone acquired the particular information “missing plug-in”, with out graphic seemed to be linked. Just what plug in is necessary, and it is this necessary…

  28. nike air max cheap - December 16, 2014

    nike air max cheap

    Graphics are one of the almost all unnoticed facets of an online site. Forget the whole SEARCH ENGINE OPTIMISATION part of it along with visualize the particular sightless, explanation we certainly have these. At this point think the fact that engines…

  29. cheap snapbacks - November 17, 2014

    cheap snapbacks

    jacksonville jaguars jerseys cheap urbeats nfl jersey nfl nike drift fashion ii jersey nike running shoes online uk nike roshe run women will smith jersey new era cincinnati bengals jerseys cheapest beats hd headphones nfl jersey nfl nike drift fashion…

  30. twitter - February 16, 2013


    […]Wonderful story, reckoned we could combine a couple of unrelated information, nonetheless actually worth taking a look, whoa did one particular understand about Mid East has got extra problerms also […]…

  31. hair loss - February 15, 2013


    […]very couple of internet websites that take place to be comprehensive beneath, from our point of view are undoubtedly effectively really worth checking out[…]…

  32. carpet cleaning - February 15, 2013


    […]usually posts some really fascinating stuff like this. If you’re new to this site[…]…

Leave a Reply

You must be logged in to post a comment.