The Power of Fear

I saw a patient this week whom I have been unable to get out of my mind. He is a man in his forties, a smoker, who came in complaining of right ear pain. As soon as I asked him what was wrong with him I could hear in his response that his voice was hoarse. I inquired how long he has been hoarse and he responded about a month. After examining his ear which didn't look too bad I told him that I need to examine his vocal cords. He refused. He said my throat is okay just let me have some antibiotics for my ear.

I asked multiple times to allow me to examine him more thoroughly to determine the source of his hoarseness but he kept refusing. As a last ditch effort I explained to him that he may have a growth or possibly even cancer of the throat. Further, I expanded that if there is something there and it is caught early there is a good chance of cure but if he waits and it gets worse the treatment would be more drastic and the cure rate would decrease. He responded "Doc, my throat is fine, really, just let me have the antibiotics". So he left with his prescriptions and I reiterated if he changes his mind to return.

As I was filling out his chart I was very concerned about the possibility of a lawsuit later on for delay in diagnosis even though he refused a complete examination. I have no doubt he will have no problem getting a lawyer to take his case. So I tried to be as complete as possible documenting the encounter and his refusal even with his knowledge of the potential outcomes. I still felt the only way to protect myself would be for him to sign an affidavit stating that he refuses with full knowledge of the possibilities but I have no expertise in drafting such a document. We often get consents to perform procedures but no formal way to consent to refuse procedures.

What really stuck with me about this case is the fear this man had. He was so terrified of the possible diagnosis that he refused to even allow me to obtain the facts. As a doctor whose goal it is to cure disease it continues to distress me that I can help this man if he could only allow me. I underappreciate the fear that some patients have when they come in. I suppose this is not unreasonable since in a fifteen minute evaluation, a person's life can be turned upside down. This man was more comfortable staying ignorant than risk the possible knowledge of a potentially serious problem. The fear of his life being turned upside down was too much for him to bear.

Often people will come to the office with nonspecific complaints regarding their throats and usually their examinations are negative. I believe that tension and stress will often manifest with symptoms effecting the throat which is why we feel choked up during periods of emotion. The throat, not the heart is truly the organ of emotion. I think many of these people are fearful of a growth and seek comfort and knowledge that there is nothing serious going on in their throats. They are fearful of having a symptom and not knowing if there is an actual problem. So here are two completely opposite patients but both motivated by fear. One is too scared to know and the other is too scared of the unknown.