Share Jean-Martin Charcot (1825-1893) at Salpetriere in Paris - a neurologist famous for the beautiful hospital, the Charcot Joint and Charcot Marie Tooth syndrome - may have initiated the term "La maladie du petit papier" observing the triviality and the seeming benefit derived by the patient. The term has become a derogatory one, however, expressing the irritation to the physician from the patient's attempt to organize his or her problems. Does not the phrase, la maladie du petit papier, uttered in contempt, give a false sense of superiority and sophistication, suggesting that one can actually say something in French?
As Koven's Perspective letter in NEJM implies, there may be more to this. "...even when I have no explanation for the headache, upset stomach, or itch - documented on the back of an envelope or punched into a smart phone, a patient feels better just having presented me with his or her recording of it. Perhaps naming our demons and saying their names aloud helps make them less frightening. Perhaps the shorthand of the list somehow abbreviates the anxiety associated with its entries."
Is not the patient, indeed, attempting to build his or her own problem list? Charcot was one of the great physicians of all time, but there was a first - greater yet - Hippocrates, who founded the very science of listening to the patient, observing the environment and documenting the patient's complaints. I rather imagine that Hippocrates would have welcomed la petit papier.
Indeed, is not the petit papier the patient's own problem list? Why not capitalize on the benefit to the patient of reducing their complaints to a problem list - be sure to include them all - and combine them with a check list of past medical illnesses, review of systems etc.? If the problem list has a placating effect on the patient, think what it does for the physician to actually see at a glance the patient's entire struggle with his or her environment and maladies. A problem is not a diagnosis, more likely a symptom, but without the complete problem list, there is no way to know that you've got it right with either the diagnosis or the underlying causes.
Suzanne Koven, M.D. NEJM 2014; 371:2251-2253; 11 Dec; DOI: 10.1056/NEJMp 1411685
As Koven's Perspective letter in NEJM implies, there may be more to this. "...even when I have no explanation for the headache, upset stomach, or itch - documented on the back of an envelope or punched into a smart phone, a patient feels better just having presented me with his or her recording of it. Perhaps naming our demons and saying their names aloud helps make them less frightening. Perhaps the shorthand of the list somehow abbreviates the anxiety associated with its entries."
Is not the patient, indeed, attempting to build his or her own problem list? Charcot was one of the great physicians of all time, but there was a first - greater yet - Hippocrates, who founded the very science of listening to the patient, observing the environment and documenting the patient's complaints. I rather imagine that Hippocrates would have welcomed la petit papier.
Indeed, is not the petit papier the patient's own problem list? Why not capitalize on the benefit to the patient of reducing their complaints to a problem list - be sure to include them all - and combine them with a check list of past medical illnesses, review of systems etc.? If the problem list has a placating effect on the patient, think what it does for the physician to actually see at a glance the patient's entire struggle with his or her environment and maladies. A problem is not a diagnosis, more likely a symptom, but without the complete problem list, there is no way to know that you've got it right with either the diagnosis or the underlying causes.
Suzanne Koven, M.D. NEJM 2014; 371:2251-2253; 11 Dec; DOI: 10.1056/NEJMp 1411685
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