Wednesday, January 11, 2012


Here, I describe an event that happened more than a decade back, when I was doing my residency in Neurology at CMC, Vellore.

A number of incidents during residency shape our method of practice in future. This communication is regarding an event that had a significant bearing on the way I deal with patients. The incident occurred in the first year of my residency in Neurology at a tertiary care centre. A 35-year-old lady consulted me for headache of six years' duration. It was described as a constant dull ache and had all the features suggestive of tension headache. A thorough clinical examination including blood pressure and optic fundi was normal. I reassured the patient and decided to start her on tricyclic antidepressants. The patient enquired how sure I was that she did not have a brain disease. With the enthusiasm and exuberance of youth, I told her I was pretty confident. I had almost forgotten this incident when she revisited me four months later. This time she had brought a computerized tomography scan of her brain that showed multiple cystic lesions. I could not believe my eyes. My confidence was shattered. However, the patient and her family were kind to me and emphasised that anyone could make a mistake. She was operated at our institute and made a complete recovery. As we have a common ward for Neurology and Neurosurgery, I happened to see her almost on a daily basis during the period she was admitted. Each meeting with her reminded me that her initial suggestion (that she might have a brain disease) was correct.

This incident had a major impact on my response to patients' opinions. As patients know their body (and disease) the best, it often helps to carefully listen to them. I have since made a number of correct diagnoses by just paying attention to what they say. It is very true that 'patients are our best teachers.'

Note: This article was first published in Journal of Postgraduate Medicine, 2004. Details are as follows. Kumar S. A Patient’s opinion is often valuable. J Postgrad Med [serial online] 2004 [cited 2012 Jan 11];50:216. Available from:

Dr Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist,
Apollo Health City, Hyderabad
Phone- 0091-40-23607777/60601066