Notes from a Healer

Once a Year

Brian T. Maurer

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Some patients I see but once a year.

Relatively healthy youngsters, they come to the office just for their annual physical examination.

Sometimes it’s required for school entrance; sometimes for sports participation.

One of the pleasurable aspects of primary care pediatrics is touching base with these families; chatting with parents, watching children grow and mature as the years slip by.

Harry was a typical adolescent in the practice.  Although I would see him now and again for the occasional minor illness, for the most part he came but once a year for a check up.

But Harry was atypical in one respect.  Two years ago I identified a mild curvature of his spine.  He had no complaints of pain or discomfort; this was merely an incidental discovery during the routine physical exam.

I pointed out the finding to his mother.  “We ought to get a baseline x-ray of Harry’s spine to document the degree of curvature.  That way we have something for comparison should the curve worsen.”

“What would we do for it?” his mother asked.

I shrugged my shoulders.  “It all depends on the degree of the curve.  Many times we just monitor it.  Sometimes if it progresses beyond a certain point, we have to intervene.”

I ran through a short list of treatment options: exercises, bracing, and possibly surgery—“but that is almost never necessary,” I said.

I handed her an order for the x-ray and directed her to the radiology suite.  “I’ll call you when the results come in,” I said without a second thought.

The following year—at last year’s exam—I noticed that there was no radiology report in Harry’s chart.  “Did you go for the x-ray study?” I asked him.  He shook his head.

Afterwards, I reiterated to his mother that we needed to have the x-ray of Harry’s spine done.  “The curve has progressed a bit,” I said, handing her a newly drafted order.

This time they went.  The curve was more advanced than I had suspected.  I called Harry’s mother to explain things.  “Harry should see a specialist,” I told her, offering the names of several consultants.  She agreed to take him.

Now here we were one year later.  Today Harry’s back resembles a gnarled tree trunk when he bends forward.  Harry claims he has no pain.  “Did you see the specialist?” I ask him.  He shakes his head.

After the exam I ask Harry’s mother to step into the room.  “Harry’s spine is much worse,” I tell her, pointing out the prominent twisted hump.  “He didn’t see the specialist last year?”

“No,” she says.  “My husband lost his job.  We had no health insurance.  I thought it could wait.  Now....”  She stares at her son’s back.  “Now that he’s working, we’re insured again.  I’ll be sure to take Harry to see the specialist.”

Harry’s mother is not a bad person.  I like her a lot.  This is a hard-working middle class family that had once enjoyed the standard benefits of the gainfully employed.  But they fell through the cracks when Harry’s father lost his job.  Their window of opportunity had closed.

Things would be more difficult for Harry and his back now that that window had been pried open again.

Like Harry’s scoliotic spine, our modern healthcare system is twisted.  It will take more than just an exercise in political will to fix it.

In this election year I find myself wondering what lies ahead, just around the next progressive convoluted bend.


About the Author

  • Photo of Brian T. MaurerBrian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades.  As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine.  Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care.  His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. Interested readers can read more of the author's writings at his website and blog.

  • Published: September 28, 2012