His own doctor/patient relationship

A retired pediatrician and medical educator who has survived numerous serious ailments writes a book on medicine from the health consumer’s perspective.

January 28, 2017 23:38
Basil Boaz Porter

PROF. BASIL (BOAZ) PORTER. (photo credit: Courtesy)

Whatever your age or medical condition, you will surely feel fortunate by comparison when reading emeritus Prof. Basil (Boaz) Porter’s new book, My Medicine, My Body – a chronicle of his ailments since childhood through his eighth decade and the lessons he learned.

The 73-year-old, South-African-born and -educated pediatrician survived appendicitis; serious acne; lower-back pain; recurrent sinusitis; hepatitis A followed by gall bladder surgery; being run over by a car in England; a large benign tumor of the parotid gland in his neck; broken bones and neurological damage when a train he boarded for Beersheba crashed into a truck stuck on the rails; cataracts; hearing loss and chronic myelocitic leukemia (CML). What a list of diseases and conditions!

But Porter survived all these and, along the way – through good treatment and bad in Israel and on several continents – reached the conclusion that “communication is an essential part of healing.” Married for 41 years, a father of three and grandfather of five, Porter nevertheless describes what he has gone through with humor despite the pain and frustration – he grits his teeth without feeling very sorry for himself, even though he almost died several times over. Published by Kotarim International Publishing Ltd. (Moshe Alon) and listed at $14.95, the 183-page, easy-to-read, humane volume is available on Amazon.

Porter has for decades been a senior pediatrician and was founding member of Ben-Gurion University of the Negev’s Faculty of Health Sciences and international coordinator of the Israel Ambulatory Pediatrics Association. He was responsible for the first teaching clinic for community pediatrics, which he established in Ofakim, where medical students and pediatric residents were exposed to the unique problems encountered in community settings.

He later established the child development center at Soroka University Medical Center and studied the field of behavioral developmental pediatrics at Boston Medical Center. Porter was also responsible nationally for the field of pediatrics in Maccabi Health Services and published the first extensive study of community-based pediatrics in Israel, where the need for widening the role of the community pediatrician was documented.

Much of his career has been devoted to improving medical education in general, focusing particularly on the importance of the doctor-patient relationship. But the doctor was himself often turned into a patient, wearing a hospital gown and feeling anonymous except when he was fortunate enough to get “Vitamin P” (protekzia or connections).

WHILE BEING a patient and a physician can have advantages, it can also be a disadvantage by knowing too much from one’s old medical books for his own good. Porter has developed his own doctor/patient relationship.

“Family will assume the doctor knows how to look after himself, and his colleagues will assume he knows what to do. The sick physician is the classic cobbler who walks barefoot,” he notes.

“The personal experience of disease, pain and suffering is insulting to the doctor, who has a lonely role. He is expected to not feel the doubts and concerns regarding his condition, to tolerate the symptoms better, to be a braver warrior facing the forces waging against his health. Sadly, the opposite is probably true.”

He suggests that there be a sub-specialty called a “doctor’s doctor” in which physicians learn how best to treat colleagues. But on second thought, he thinks it’s unlikely to come about.

Porter describes with irony how “truisms” that he learned as a medical student, intern and resident turned out to be false, such as that “keyhole surgery” was dangerous and less preferable to opening up the patient. He also marvels at how advancing medical technology treats health problems that used to be incurable, such as one Gleevec pill every morning to turn his CML into a manageable chronic disorder one could live with.

Beginning with a quote from 18th-century writer and physician Oliver Goldsmith – “You can preach a better sermon with your life than with your lips” – Porter tells his lifelong medical story.

“In my student days 50 years ago, most clinical medicine was based on wise doctors talking about ‘in my experience.’ Chromosomes had only recently been properly documented, and the lecture on the structure of DNA was about a new discovery. Our revered professor of surgery berated keyhole surgery, insisted that any decent surgeon needed to make an adequate wide incision in order to operate properly.”

As a child, his infected appendix was removed in the nick of time via a long incision. “In the early 1980s, my gallbladder as removed leaving a long scar under my right rib cage, probably the last one of its kind.” Ten years later, laparoscopy via keyhole was commonplace.

While a doctor will nod when a patient says a cocktail of onion and honey every morning kept him feeling well, he or she will not recommend it to others without its efficacy being proven with evidence-based medicine, he notes.

At the age of 12, he suddenly developed severe abdominal pains after consuming his favorite breakfast of strawberry milk shake and scrambled eggs on toast. The pain didn’t subside but only worsened, landing him in the hospital where his appendix was removed. Placed by hospital staffers in a jar next to his bed for admiration, it looked like “a yellowing worm-like object floating in liquid.” In those days, x-rays and taking a family history were used for diagnosis of appendicitis but not very accurately; today, ultrasound or CT imaging is used for exactitude.

“I will not be exaggerating if I say that there was serious concern for my survival as I threw up all over the operating room during surgery.” Unlike today, he was told to stay in bed for weeks instead of the better advice to get up and move around to prevent blood clots and improve digestion.

At 14, his face and back were covered with pimples and pustules, nothing potentially fatal, but the solutions and creams and weekly visits to the doctor did not improve things, causing severe damage to his self-esteem.

AFTER A three-year pediatrics residency in the US, Porter returned to Israel, only to suddenly suffer from horrendous lower-back pains, causing him to think – like anyone – that he had developed a malignant tumor of the spine or something else just as ominous. In a hospital, he was given Valium that caused him to feel “stoned.” He underwent physical therapy, used a pillow when he drove and gradually felt much better.

He learned that some scans show nothing serious but the pain remains, and vice versa.

“A good clinician will never rely on the clinical picture, a CT or laboratory results alone to reach a diagnosis,” he concluded from the experience.

When spending some time as an intern at Ziv Medical Center in Safed, he contracted highly infectious hepatitis A and was so jaundiced that he turned orange. He seemed to recover, and then his wife and two small children got infected as well. They healed quite easily, and they went to visit family in South Africa, but Porter developed a second, very severe case of hepatitis A there. He was treated by a doctor from his childhood and a liver specialist was called in as it got worse. He was diagnosed with Gilbert’s syndrome, a genetic disorder that involved poor bilirubin disposal. He needed surgery to remove gallstones due to gall bladder colic.

“It was one thing to study symptoms of liver disease or gall bladder colic in a textbook and practice the learning while taking histories from patients. Personal experience was a different story all together.”

After suffering great discomfort, including nausea and severe itching, he got better – gaining first-hand appreciation of what patients really go through.

While walking with his 13-year-old son in Hampstead Heath in England, he was a bit careless and was hit on the right knee by a car at a crossing. His son was not hurt, but Porter was in terrible pain. He and his family decided nevertheless not to cancel their planned skiing vacation in Switzerland; as his knee doubled in size, and he went to a ski clinic. Back in London for further treatment, he learned that if you want National Health Service treatment, you have to wait months, but privately – which he chose – it would take mere days. He gradually recovered.

Another time, he was diagnosed with a parotid tumor after being misdiagnosed by several medical specialists. In Boston, he received excellent and efficient surgical treatment and returned home to Israel.

It was the train crash that caused him devastating damage. A crushed third vertebra was removed, a bone graft inserted and a titanium plate attached to fixate his spine. He had also lost consciousness from a blow to the head. Although surgery was successful, he suffered paralysis of his right arm and a bed sore with pus developed on the back of his scalp, even though it should have been prevented by proper hospital care. He lost 17 kilos and had to forgo his amateur violin playing. But even these problems resolved themselves.

But then he developed neuropathic pain with allodynia – pain from stimuli that are not normally painful. The slightest touch to his upper right arm was “like being stroked with barbed wire.” He was given a morphine self-regulating pump that he could use electively to give himself pain relief. Without this, the pain was excruciating. An American-trained specialist mapped out an area of one-square-centimeter on his arm that caused the pain. Oddly, he noticed that when he was lying in bed or when busy at work, the pain disappeared, only to return at other times.

He even was licensed by the Health Ministry for medical cannabis, which didn’t help him at all. Nevertheless, “every morning, I try to remind myself that I was a few millimeters from being a quadriplegic” from his accidents and that “basically, I have a well-functioning body.” Pain, he told himself, was part of his being.

“It is a life challenge meant to teach me that the human body can deal with practically anything, even the most unpleasant and complex of incurable sensations.

Ashamed of having hearing problems, he finally gave in to family pleas and vanity and purchased the expensive kind of hearing aids that were less noticeable behind his ears. He also had cataract surgery, but nevertheless felt it made him feel he was growing old.

Although he thought the train crash and his parotid tumor were his “final major body events,” he was shocked to learn from a very high white-cell count that he had contracted CML, but that type of leukemia can be lived with the “magic pill” Gleevec. His white cell count, thankfully, returned to normal, and he is now in complete remission.

“Having experienced boutique care, I am highly aware how crucial the process of care is to the wellbeing of the patient and how rarely this process is managed appropriately,” he writes sadly.

“My thoughts often wander to the masses of patients out there who do not have the cash or connections to achieve what is needed in the quickest and least bureaucratic way. And also how easy it is to lose all proportion. How quickly one forgets the terror of the initial uncertainty accompanying the cancer diagnosis and how quickly banal issues of everyday life replace the fear of losing life itself.”

ALL THESE personal experiences changed his attitude as a physician. He always thought of himself as a doctor willing to listen to patients’ problems, showing understanding, but “each experience as a patient added a new layer of understanding to the true meaning of empathy.” A number of doctors here and abroad whom he had encountered “did not even bother to relate to me as a human being.”

Medicine is more complicated than looking at test results and reaching conclusions.

“Medicine today frequently involves people with many complaints related to many systems and problems that become chronic and don’t go away... We have got to know more about the people themselves, their lifestyle, their work, their families and their stories.” Patients need more words of encouragement and reassurance, he adds.

His main hope is that the end of his life will still be a few years away and – even more important – be swift and painless,” Porter concludes.

“I also hope that the doctors I meet along the way, besides being competent and updated in their field, know how to smile and say: “Hi, how are you feeling today?”

None of us can ask for more.

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