Narrative Medicine: Pathology and Pathophysiology of Palindromic Rheumatism

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The first home visit I had with my patient was an eye opening opportunity. It was one that was in stark contrast to what I had imagined before going over. This patient had palindromic rheumatism that affects different joints in his body, whenever he gets stressed. Also, he suffers from osteoarthritis in his spine as well as his knees and had both knees replaced due to the degeneration of osteoarthritis to osteonecrosis. He also did mention that he might be having an operation on his spine soon.

It became apparent later that he had many underlying causes to his suffering, first of which, was him running his now arthritic hand through a conveyor belt 10 years back while working as a police officer accidentally, causing a complete sensory loss to his forearm as well as his digits.

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Within a period of 6 months, he had undergone 2 knee replacements after going through the NHS ‘choose and book system’. At both times, he was given a nerve blocker. Although he was able to flex, extend, lateral and medially rotate his leg, it was evident from his facial reactions that he was still experiencing pain.

Moreover, I understood from his wife, now his main caregiver that my patient has been off all his medication and has not attended any physiotherapy after the initial 4 sessions as he found himself ‘alright’. Nevertheless, with the advice of their general practitioner, they had gotten a cycling machine for him to go on for 15 minutes, three times a day and his wife also brings him for regular walks with the assistance of a shooting stick.

I was alarmed that my patient did not take his medications and also did not attend the physiotherapy sessions that might help him get better. It was rather difficult not to give any advice, given that I had worked as a shadowing Dr. back in Singapore for quite some time. However, I knew that I was not supposed to give any advice or examine my patient since I was only a 1st-year medical student.

As a first-year medical student at the University of Buckingham, I have erudite the significance of listening because when I was listening to my patient, I was observing his gestures at the same time. Although at times, he was brushing off minuscule information, I could study his movements and understand his situation. At some point in time, he asked me to do some test to check the back of his knee for any inflammation as he was finding it difficult to extend his leg. Although I saw a bit of redness while he was showing it to me, I clearly mentioned to him that we were not permitted to do so yet and this would be one of the best reasons for him to either visit the doctor or go back to having his regular physiotherapy.

Now, my goal for my doctor as a professional narrative medicine course is to establish a better communication with my patient using the GMC guidelines as well as find out the underlying cause to his diagnosis of palindromic rheumatism.

This would be measurable by me gathering more information from my patient, which would be evident in my extended case analysis. Furthermore, I had signed up for two conferences via the royal society of medicine with regards to the importance of better communication as a doctor and common causes of arthritis. Hence, I would be getting a certificate too.

I would be able to attain this, with the presence of a pre-planned template, which includes reading up information on palindromic rheumatism from textbooks, research articles from sites such as Cochrane review and PubMed. In addition, I have signed up for a few conferences as well as workshops held by the school to build more on my communication skills as well as gather more knowledge from people around me. I understand that communication has extreme significance in playing a part to construct a notable rapport. According to Payne (2007), communication and information provision play a crucial role in deciding if people engage in suggested health behaviors and if the behaviors have an optimistic outcome.

Performing exceptionally well in doctors, as the professional program is essential, to my rudimentary knowledge. The foundation of medical pathology concerning ethics and practice standards is vital. With this in mind, when my goal is accomplished, I would feel more assertive and at ease in engaging with patients in the ward during clinical placement in phase 2. Furthermore, I will also have a greater understanding of my future specialist course in the upcoming years.

I am allowing myself time till November 2018 to study and understand the pathology and pathophysiology of palindromic rheumatism in order to attain a deeper understanding of the situation my patient is suffering from due to its rarity and gradually build my communication skills with him.

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