Let's start with the obvious:  Every doctor wants to help his or her patients. And one of the best--and accepted--ways we do this is to "keep current and up-to-date" on the medical literature.  We attend meetings, read articles, and discuss the latest medical advances with our colleagues, and even embark on research projects of our own to publish data and learn more.  But even with the best of knowledge and employing the latest treatment techniques, sometimes we have "medical mysteries" that could qualify for an episode of "House" on TV. Euphemistically sometimes called "problem patients", they sometimes can be one of the best "research projects" for the practicing allergist.   In short, there is enormous learning potential we might reap when the following scenario occurs:

The "problem patient" who returns to our office, and--through no help of our own--is feeling better and perhaps even is totally well.  

Most of us have had this experience--a patient we've struggled with, in terms of finding the correct diagnosis and/or the correct treatment. We've run tests, tried medications, and each time to no avail.  We've reached a "dead end", and despite our bleak outlook for them, the patient returns and is better.  We're dumbfounded.  Perhaps even have that "deer caught in the headlights" look on our face when we walk in the room and see the patient is so much better.    

And in my own experience it takes quite an act of humility to take a deep swallow, and ADMIT that we didn't help the patient--something--or someone else--did.  To soothe our bruised egos, it's all to easy to "blow off" or deny the patient is "really, truly, better"--especially if we had no hand in it!  But here's the catch--a patient like this may be an extraordinarily valuable teaching tool for us to learn something new and valuable in helping other patients in our practice.  Again, (and I've said this before) the keys to being a superior allergist don't lay in just technical knowledge, our skill-set needs to include a liberal dose of curiosity and compassion with each patient we see.  In short, we need to ask (and hopefully answer) the question as openly and honestly as possible--how did this patient return to health?  Can I learn anything from this patient's experience that might benefit others?  

Flashback:

Time:  late fall, 1978

Scene:  A hospital ward, Chicago Illinois.

A young doctor is paged to answer the phone for an outside call.  He takes the call.  "Dr. Kroker", the patient says, "just wanted to call you and thank you for trying to help me, but because I wasn't getting the help I needed, I began seeing Dr. Truss in Alabama.  He put me on an antifungal medication and I feel so much better--my allergy to molds and foods have nearly gone away!"

I had known the patient well.  She had been a real "problem patient" for me, and I had struggled with her to no avail.  But I was curious.  So I gave Dr. Truss a call.  He explained to me the important role that Candida Albicans seems to have played in many of his sickest patients, and promised to send me a copy of his article when it was published.  

That one phone call by me began a life-long odyssey into treating patients for Candida-related illness over the next 32 years.  (You can download my lecture in the "Powerpoint lectures and annotated SLIT Bibliography section").  Fueled by curiosity, I was  given "the gift" of a phone call from my "problem patient", and I made contact with an individual (Dr. Orian Truss) who could help me view some of my most difficult and challenging cases in a new light.  

Flashback #2:

Time:  Sometime in the early 1980's.

Scene:  A midwest clinic, in the family practice section.

A family physician observes an odd phenomenon:  many of his difficult patients have gone to La Crosse WI and seen a doctor who placed them on "allergy drops"  (SLIT) and they got better.  He asked the question:

how did these patients return to health?  Can I learn anything from this patient's experience that might benefit others?  

Subsequent to this, he called me, and a mutual friendship developed, with sharing of patients over the years and additional healing for many other people.   

Problem patients?  In the truest sense of the term, I think not.  It may sound trite, but problems are merely solutions that haven't been found.  Sometimes, we have the opportunity--the privilege, if you will-- to learn alot from our most difficult cases when they occasionally return to us and are improved after seeing another health-care practitioner or pursuing another treatment that results in dramatic improvement.  If we swallow our pride and egos, and explore a little bit, they can become our own individual "research projects"  and in a sense sometimes even become our benefactors.

Something to think about.

Later, Dude