There exists something in medicine called the “doorknob phenomenon.” It’s when a doctor, just about to leave the company of a patient (with a doorknob possibly in grasp), finally hears them divulge what has been weighing most heavily on their mind. Recently, a form of this phenomenon happened to me.

In the midst of a busy outpatient clinic, I was handed a chart. Attached to it was a referral note that read, “lymphadenopathy NYD,” which meant swollen lymph nodes that were “not yet diagnosed.” My patient was a middle-aged man, and quiet. I gleaned from talking with him that he lived an uneventful life. Pea-shaped lumps dotted his neck and armpits, and as I rolled them between my fingers I flipped through my mental checklist of potential diagnoses: the effect of medications, infectious exposures, the spread of possible cancer. I wasn’t yet sure of what caused them, I told him. I tried to be reassuring.

Related

But as the exam went on, I noticed a change in his expression. Starting to explain the tests I would order, I saw that his feet began to shift, and he tugged nervously at his sleeves. “I get the sense something else is bothering you,” I said. His eyes then glossed over, and he began to cry.

In moments like these, I stumble. As a physician, my focus is roped tightly around a very narrow notion of healing: I follow a blueprint of tabulating signs and symptoms, rendering diagnoses, and setting forth treatments. But in practice, this script is prone to unravel, because at its end lies the larger and fraught forces that truly affect my patients’ health.

I spend a significant amount of time learning about my patients’ plights: the lack of money and food, the troubles with finding a job or a house, or the addictive substances that can........

© Salon