By Joe Burns

The elderly female patient was a frequent visitor of the dermatology clinic.  Her physician had provided routine care for her, removing suspicious spots for decades.  Today she was presenting for an exacerbation of her psoriasis.  We entered the room and the patient was visibly distraught.  She was wearing a wrinkled t-shirt and old jeans, a stark contrast to her usual Southern Lilly Pulitzer dresses.  As we began taking her history, she broke down, bawling over her psoriasis…

“I just can’t do this anymore.  It is just too much.  I have been through enough.”

We knew there had to be more to her story.  A corticosteroid cream may be an annoyance, but was surely not enough to cause this immense distress.

Our approach was direct.  The physician took her by the hand and looked into her tear soaked, glassy blue eyes and asked, “What’s really going on?”

Through her sniffles she began to share a story of personal tragedy.  Five years earlier her husband had a massive stroke and has since been home-bound, our patient his primary caretaker.  Two weeks ago, she found out that he had been diagnosed with metastatic cancer and that he was not expected to survive the year.  She was devastated. For years she had driven him to countless appointments, prepared specific meals, did her absolute best to provide him with a safe, secure medical home.  She felt that she had failed. She felt that it was her fault.

She needed more than a skin ointment.  We spent the next thirty minutes just talking, letting her tell stories and work through the issues she was experiencing.  It was evident that she required more psychotherapy than we were prepared to provide, so she was referred to psychiatry for follow up.  However, after just a half hour of sharing these issues, she looked evidently better.  She embraced the physician and me on her way out, expressing her gratitude for serving as a source of support during her stressful time.

“There’s a person in there,” the physician reflected to me in the confines of his office.

The patient was not psoriasis in the first exam room.  She was a patient, experiencing psoriasis in the midst of a major life crisis.  We must seek first to treat people, not their diseases.  We must immerse ourselves in their lives in order to best understand how to remedy their maladies.

By committing ourselves to understanding not just disease, but also people, we may better develop our care plans.  Elevated blood pressure transforms from essential hypertension into daily stressors of economic injustice and food insecurity.  Poorly controlled diabetes is no longer an elevated A1c, but also lack of availability of test strips for an earlier generation glucometer at the local pharmacy.  In broadening our understanding of the social determinants of health, we are able to integrate this principle of humanistic care into our practice.

Joseph Burns is a member of the Class of 2019 at the Herbert Wertheim College of Medicine at Florida International University in Miami, FL.  He is passionate about the arts and community engagement, having served as the Art Director of the Mammography Art Initiative and currently as the Community Service Chair for the Panther Learning Communities.