PERIPHERALIA

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Every now and then a patient comes in to see me and starts 
with the statement, “I’ve got a long list for you today”, and 
I find myself gripping the edge of my consulting room 
desk just a little firmer than normal. They then unfurl, like a 
long scroll, their list or open a diary with two full pages of 
recordings on it.  There is a law of the universe that states 
that this patient only comes in when I am already running 30 
minutes late.

I then try and steal an upside-down look at the list to see 
what is coming. Written at the bottom of the page, after 
the list of complaints, is the shopping to be done at the 
supermarket after seeing me; so eggs, bacon, and fresh 
cream come after haemorrhoids and indigestion. The French 
physician Jean-Martion Charcot described this condition in 
the 19th century as La Maladie du petit papier, the disease of 
the little paper, which has now been updated to La Maladie 
du Grand Print-Out.  

There is also another form of note-carrier who writes 
everything down “in case I forget something” which slightly 
begs the question of the importance of the ailments.  Yet 
another form of list seems to have arrived on my desk recently 
because someone has been selling my patients home 
blood pressure measuring machines. The blood pressure is 
neatly recorded, often several times a day, creating much 
conversation and confusion.

Long ago, I had a patient who had post colectomy diarrhea. 
She used to come and see me almost every week. She recorded 
each bowel movement with a tick on the back of the envelope 
in which I had sent my last bill for her previous consultation. 
I am not sure if this was an unconscious comment on what 
she thought of my account. Sometimes there were only 
three or four movements a day while on others there were 
up to eight or more. We would go through the motions (so to 
speak), although it was a fairly monotonous affair as the plot 
never seemed to thicken. During the consultations I would 
find myself sliding down into the space-time continuum and 
immediately afterwards my receptionist would come in and 

chisel me off the floor then shake me by the shoulders until 
the glaze subsided from my eyes. 

Once a new patient came in to see me and reeled off twenty-
four complaints. I had difficulty keeping up with her as  
I furiously wrote each one down.  I looked after her for ten 
years and at the end I had reduced the number to eighteen. 
Say what you will, it could have gone the other way. Imagine 
if we had ended up with thirty complaints! She was suffering 
from what Kierkegaard called The Sickness unto Death.

When one is aware of the dynamics of these consultations, 
it is possible to move on to a realistic program of care and 
containment as the lists often represent anxiety, depression 
or mostly loneliness. Some are explained on the basis of 
various psychological disorders including somatoform and 
somatisation disorders. Other list makers may represent busy 
patients in a complex informational world simply seeking 
what one observer stated was “clarity, order and control”.

I have been fortunate enough to often have the time to 
listen and listening is generally the main therapy. The mere 
act of writing the complaints down and discussing them is a 
confirmation of their existence. It is sometimes enough just 
to be heard. In the substrata, though, there are some physical 
and mental illnesses to be treated.

Almost all doctors, unless they are up for sainthood, may 
have less than laudable and seemingly uncaring responses 
to these lists. This is because there is a dissonance between 
the expectations that a patient has of a doctor and the role 
that the doctor has been trained in. It is also partially due 
to the everyday pressure cookers that most doctors find 
themselves working in and part of our own humanity as we 
strive to heal the patient’s illnesses. Negative reactions and 
an ethic of caring are not mutually exclusive. You are allowed 
both.

Chris Ellis is a family physician from Pietermaritzburg, 
KwaZulu-Natal

Email: cristobalellis@gmail.com

“I’ve got a long list for you today, doctor”