Dr. Malcolm Robinson's Foreword | Dr. McCarberg's Foreword
This is an amazing book, researched and compiled by a remarkable author. Although I suspect that Just Fine will be a wonderful support source for patients, this book also should be required reading in every medical school, and practicing physicians should avail themselves of this unique opportunity to better understand a major subset of their patients.
The practice of medicine is exactly that: an attempt for physicians to continuously enhance their medical and scientific awareness, technical competence, and compassion. Most of us never completely achieve our personal goals in these areas. Some fall behind more than others.
One of the greatest challenges to any physician is any apparent disconnect between patients’ medical histories and their appearances. Although remarkably few patients purposely attempt to dupe their physicians, healthcare professionals seem to have a morbid fear of possible malingerers. As a result, physicians, when confronted by the kinds of patients that are so well described in this book, find it exceptionally difficult to achieve empathy and compassion. Such just fine individuals are very common and often terribly depressed and discouraged due to the fact that the medical profession frequently fails to meet their very real needs.
Doctors can be prisoners of numbers. If their physical examinations and favorite diagnostic tests seem to be normal, the patient’s symptoms must somehow be imagined. Of course, the converse is almost universally true. In fact, the patient who describes serious symptoms without any immediately diagnosable malady is almost always correct in appraising the true state of their own health. Physicians who tell such patients that their illness must be due to stress or that their symptoms are all in their heads are almost always dead wrong. The wise physician must often admit an inability to define a diagnosis at a particular moment in time. Nevertheless, patients know their own bodies best of all, and they should always be assumed to be correct when they describe their symptoms.
Many of the patients in this wonderful book are strangely familiar to me since my own practice has included multiple replicas of their poignant stories. Despite my own best efforts, I have not always been as supportive, understanding, and helpful as my own patients have deserved. I wish that I could have done much better. Gastroenterologists see a great many patients with disabling disorders such as Crohn’s disease, ulcerative colitis, and severe irritable bowel syndrome. Many of these patients look as healthy as can be, and most have had negative experiences with multiple health professionals. Even the most modern and highly trained physicians often have little knowledge permitting them to successfully diagnose, treat, and support these patients who appear just fine. The medical graduates of the twenty-first century are the most scientifically aware in history, and their heads are full of esoteric diagnoses and explicit management approaches to dire disorders of all sorts. However, many are absolutely stumped by the healthy appearing person who describes symptoms that seem monstrously out of proportion to his or her demeanor. Physicians are driven by many impulses other than the simple desire to care for their patients. We live in a litigious era, and managed care organizations and insurance companies are vigorously upholding tight cost controls. As a result, there is much pressure to minimize diagnostic testing and to have such testing guided mostly by objective findings rather than symptoms. The patients who suffer the most from such managed care constraints are the just fine individuals who would seem able to survive nicely without expensive testing or treatment. Although I am not naïve enough to think that all doctors will buy this book and read it, still, I hope that many will do so. If they do, it will make them better doctors. Whether healthcare professionals read the book and learn these precepts or not, this book is certain to be a godsend to a great many patients. If nothing else, they will learn that they are in very good company indeed. We all must be indebted to the patients who were willing to bare their souls in order that others understand the mysteries of patients who are ill but who appear to be just fine.
Dr. Malcolm Robinson, MD, FACP, FACG
Gastroenterologist, Clinical Professor of Medicine
Medical Director of the Oklahoma Foundation for Digestive Research, with
thirty-four years as a clinical investigator of gastrointestinal illnesses