Lealani Mae Acosta
Nashville, Tennessee, United States
|Illustration by Lealani Mae Y. Acosta|
What makes a “good” patient? What makes a “good” doctor?
I am a cognitive behavioral neurologist who specializes in dementia. I relish the longitudinal relationship I have with patients and appreciate hearing them say with pride, “Dr. Acosta is MY doctor.” Being someone’s physician means having a personal relationship, knowing their history, eliciting pertinent exam findings, having the knowledge to diagnose correctly and the wisdom to treat appropriately. I knew my role and I knew my patients; in my mind, this is what it meant to be a “good doctor.”
I had been seeing Mr. M for years, a patient with progressive supranuclear palsy (PSP). His symptoms had followed a classic trajectory of decline for this disease: proptotic stare, masked facies, resting tremor, and a shuffling gait with several falls. Within the past year, he had also developed dysarthria and dysphagia. We had tried different medications to control his symptoms with varying levels of success. He had been receiving excellent physical therapy and speech and language pathology services. He was still a strong, robust man, and continued to score well on cognitive testing. I always had to brace myself to test his upper arm strength; with his barrel chest and muscular arms, he could still easily knock me over. He usually came dressed in golfing attire that hinted at a history of athletic prowess. Mr. M was a “good” patient: he took his medications, kept me appropriately updated, and had reasonable questions and expectations.
Mr. M’s wife had contacted me with the news that he had experienced an acute worsening of his speech and swallowing and was in a local hospital. The consulting neurologist believed that this was symptomatic progression of his PSP, so no further diagnostic or therapeutic interventions had been discussed. But with the abrupt decline his wife was describing, I posited he might have experienced an ischemic stroke. Although a head CT had been performed on admission and read to be negative for stroke, important decisions such as the surgical placement of a feeding tube depended greatly on a correct diagnosis. I spoke with the admitting physician, shared my concerns, and recommended doing an MRI of the brain. The MRI did in fact show a new cerebellar infarct, which radically changed the course of his outlook and treatment.
Did knowing Mr. M’s history and abilities make me a “good” doctor?
Ultimately, I believe that being a good doctor means having the grace to treat and respond to each patient who walks into my office. We understand each other’s goals, limitations, and boundaries and treat them with respect. Our interactions should leave both doctor and patient better for that therapeutic relationship.
LEALANI MAE Y. ACOSTA, M.D., M.P.H., is an assistant professor of neurology at Vanderbilt University Medical Center in Nashville, Tennessee, USA.