What did I not do right?

I was in a stone clinic, as part of my urology placement. This clinic followed up patients with kidney stones.

It was a really busy afternoon with steady stream of patients coming in and out. Some of them were offered surgical treatments, others medical and/or lifestyle advices. Most importantly, they left with a better understanding of what has caused their symptoms and were relieved to know that something could be done to ameliorate the pain.

Then, there was this particular man, coming in for multiple renal stones. He has not had an episode of acute renal colic but was dreading the thought and the possibility of it.

Since the last episode (20 years ago), he had been heeding doctors’ advice – drink plenty of water, increase intake of lemon juice or anything citrus-y. He had undergone various medical and surgical treatments possible for his stones and various investigations have been done over the years. But the stones just won’t leave him alone. His latest scan showed that he might have new stones being formed and some of the old ones have moved slightly.

He was upset but did well in trying to conceal his emotion by cracking several jokes and several awkward laughters.

And then, he asked the doctor, ‘what did I not do right?’

The doctor replied ‘nothing’

‘Things happen.’

I think it is human nature for us to piece everything together. We desire certainty and answers. It is tempting for clinicians to put a finger on a cause of a disease and blame certain lifestyle factors as the reason for the formation of the kidney stones. And it can be a blow to our ego if we cannot do that when patients expect us to.

But, sometimes, clinicians just could not pinpoint the cause of a disease. A patient may be doing everything right but still get the disease. The disease becomes one that is idiopathic in nature – ‘idiopathic’ being a fancy way of saying ‘I don’t know’.

Some patients are not bothered by this fact. Others lose trust in the clinicians and start to doubt their competency. in other conditions such as cancer, not knowing why you develop cancer can be extremely disturbing and devastating.

Having said all this, I personally feel that it is perfectly fine for doctors to be honest towards the patients and admit that we do not have the answers to all things medical.