Barbara was a worried-looking middle-aged lady I first met many years ago. When she consulted me for the first time, she came well prepared. The folder she was carrying was a more impressive medical record than any academically inclined GP would have written about a long-suffering chronically ill patient.
There were all manner of test results, CT scan reports and correspondence about her medical history between a vast array of medical specialists.
Although she said that an old patient of mine had recommended me to her, she was honest enough to admit she was at the end of her tether and that I was her “last hope”. I assumed that she thought saying all this was a back-handed compliment and that it would endear her to me and make me think a bit harder about her problem.
The agenda well set, I spent a fair amount of time perusing the folder. I made it clear that because of the complexity of her problems and the appointment style of my practice, I would unlikely to sort this out in our allocated 30 minutes, and we may have to meet for a follow-up visit. From what I absorbed by scanning the contents of her folder, I quickly concluded that there was nothing much that had not been done in the way of investigating her problem. In summary, Barbara had chronic headaches and no one had been able to give her a definitive diagnosis or treat option that helped. Needless to say, it appeared every conceivable treatment in the medical dictionary had already been tried out.
However, given that she had seen close to 100 different doctors and had spent several years chasing a diagnosis, but was still sitting there in front of me alive and looking quite well, I was quietly confident that her problem was not a progressive pathological process.
However, how could I possibly add anything to the collective wisdom of all those doctors already consulted?
I was in the middle of formulating an opinion and wondering what to say, when she abruptly asked me; Well, Doctor, what would you do now if you were me??” I just had enough chance to gulp, look up and, perhaps to lighten the mood of the situation so I could think a bit more, said: “Given this condition could eventually prove to be something quite incurable, I would revisit all the major European cities and spend a day or two in each one again, refreshing all the sweet memories of my youth and all the adventures I had got up to in my heyday.”
At the end of the visit, Barbara left in a much lighter mood, I felt, and said that she would actually think about my suggestion and “seriously so”. She mentioned she had some money saved and it sounded as though she could afford a trip like the one I had just prescribed.
I thought no more about this until a few weeks later when I started receiving postcards from her from all over Europe, almost one every day! I received 27 of them in all, and I still have the collection somewhere in the deep recesses of my surgery’s storage room.
She eventually returned for her second consultation about 6 months later, but this time not with a medical folder but with a large photo album. After a detailed report of her itinerary, she said that from the second day of her European trip, she just did not have time to think about her headaches. She was concentrating on catching the right train to the next destination, and the next ferry and the next bus, and by the second week of her holiday she realised her headaches were gone.
She still sees me regularly for her general health issues, but never in 20 years has she mentioned a headache again.
Barbara is one of my more memorable success stories and to date give me credit for curing her headaches.
However, I doubt the orthodox practitioners of evidence-based medicine would be handing out any credit to yours truly these days for such a unique treatment plan.
Originally published in Medical Observer- 15/07/2011