Oh dear, I must have deleted, accidentally, the post I was working on.  Well, here is the updated version.  The subject, getting a dog.  Wife and I have been together for almost eleven years.  Only recently, we have been talking about getting a pet, a dog.  I grew up with pets, dogs, cat,  tropical fish, hamptsers, andthe other temporary types, frogs,  rescued birds, and kittens.  Having a pet in the house seems natural to me.  Unfortunately, not to Wife.  “They are animals!” That pretty well sums up her feelings about pets.  They can be cute, lovable, fun, but they do not belong in the house, on the furniture, around your feet.  They cannot make a sound during quiet times, and they need to be trained by me to stop at thresholds, boundaries and stay in a crate when their prescience is not appreciated.

Of course, my feelings about a dog are quite different.  I grew up with dogs, first a mutt named Sandy, (guess why,) then a Springer Spaniel who lived and shared our next 17 years.  Once established in a home as an adult, we had a Husky, along with a Golden, and then an English setter, along with various numbers of cats, (as many as twelve, including kittens), hampsters, and snakes (which my son collected in the yard and woods.)

Wife, on the other hand, did not grow up with pets.  Her family during her”growing up” was large, urban, and primarily concerned with the nearby beach and sports.  Pets were not in the picture.  She did, as an adult, have an “outside) cat which disappeared during a remodel, and that is it.  So, the difference in attitude.  She never had the opportunity to bond with a dog, be the close companion with an animal who loves you, is loyal, never makes demands beyond food, shelter, and shared time.

OK, so, what is the problem?  Are you kidding?  Major culture clash!  The dog must act like a person, but be only a part time participant in our “human” activity. (  Not that I want to sleep with a dog on the bed, share my meals with the dog, or spend all my time with the dog, but dogs often want to do those things with their companions. ) So the line must be drawn.  I do not want to feel guilty about the dog acting like a dog, I do not want to be in the position of apologizing for the dogs transgressions.  There is no wiggle room in our discussions so far, and I am hesitant to push.

Now, why did the “pet” subject come up anyway?  I have had a few medical issues lately, including a recurrence of depression requiring medication and counseling.  A daily companion appeared to be a good adjunct to my therapy, brought up by more than one person.  Thus the problem.  I would love to have a dog, as a companion, as someone to share my considerable free time every day.  Sure, I take walks, putter in the garden and yard, do housework,  write, read, buy groceries, cook, etc.  My time IS filled.” But much of that time, many of those activities could be shared with a dog, and thereby made more enjoyable.  So, where do we go from here.

I told wife after our last discussion that it seemed that a dog would bring up,points of contention that were not now a problem, and my potential enjoyment  was not worth the potential strife.  Not surprisingly, Wife did not object.

So, no dog.

One of the first instructions from our physical diagnosis instructors in medical school was to write down the patient’s words, specifically why was he or she seeking medical attention, what brought humor her to the doctor.  Of course, by the time a student got to the patient in a hospital bed, he/she had answered that question two or three times, primary care MD, specialist, resident, intern, etc.  but the lesson to learn was to listen to the patient, not the introduction often provided, “go do a history and physical on the gallbladder in room 3009.”

Wrong already, the patient is a person, not a procedure or a room number, he/she has a name,  and has complaints that may or may not be related to gallbladder disease.  Mrs Smith is in pain, frightened, and probably has little knowledge of what is ahead of her.  The value of the student’s interview and examination is at least twofold.  The student may find signs and  symptoms of a concurrent problem, or maybe even of a different diagnosis.  The plan of treatment might have to be modified, or further testing and observation may be indicated.  If an examiner approaches a patient as a person with something to “tell” him, he is more likely to find the “other problems” than if he were to focus on the diagnosis from the beginning.  Perhaps Mrs.’ Smith’s symptoms and exam are not typical of gallbladder disease.  An approach focused on confirming the diagnosis provided beforehand allows complicating factors such as undiagnosed diabetes, bleeding problems, etc. to be overlooked.

The educational value of the student interview and exam is great. Learning the multiple manifestations of a certain condition is a necessary step for the student.  Future patients may not have the same constellation of findings, maybe only a few will coincide.  With a more open the interview, that is, one with more open-ended questions, the student, who is patiently and carefully listening, will collect more information.

Not all the student writes down will be helpful right away.  But on a subsequent admission, perhaps in an urgent situation, or even in a trauma setting where a complete past history may be difficult to elicit, the previous record may be very valuable.  It will provide past injuries, previous surgery, bleeding tendencies, medications and allergies, underlying conditions such as diabetes, coronary heart disease, etc.

Patient, empathetic listening is difficult, at times.  Doctors are often working on a schedule that limits the time they can spend with individual patients.  Emergency calls, unexpected complications can interrupt or shorten a scheduled visit.

As a student on my second medical rotation, I had plenty of time one evening to interview a middle aged woman with the “chief complaint” of “Doctor, from the day I was born my body has been wracked with pain from my head to my toes.”  Perhaps you can imagine the hours I spent recording her symptoms, all the time thinking that my resident, who assigned me this patient, was playing a joke on me.  The lesson I learned, was that patience and skill are required to sift through the many symptoms in this obviously hysterical personality to be sure that any “real” problem is not overlooked. One cannot assume that all the patient’s symptoms are imagined, just because most of them are.