Patient–Doctor

• Physician-patient relations
• Spondylitis, ankylosing
• Medical errors

On a recent visit to New York City, as I was taking a 15-block walk in midtown Manhattan, I was thinking about how fortunate I have been. In 1998 I underwent a transluminal coronary angioplasty with stent placement and subsequently I received anticoagulant therapy, which resulted in painless hematuria. This led to the discovery of renal-cell carcinoma, for which I had a radical nephrectomy. This experience has prompted me to share with you my perspective as a patient for 44 years, now facing the added uncertainty that a cancer patient has to live with.

You see, I have had arthritis since age 12, and my physician at the time, the chief of orthopedic surgery at the local university hospital, treated me with frequent bed rests and hospitalizations. There were no rheumatologists in Pakistan in those days. He at one point prescribed 1 full year of antituberculous treatment (streptomycin injections, isoniazid, and para-aminosalicylic acid), without any resultant clinical benefit. Later on, he treated me intravenously with honey imported from West Germany. By then I was 16 years old and had just become a medical student.

Two years later, during my first clinical rotation in medical school, I spoke to my teacher, a professor in the department of medicine, about my symptoms. He examined me and diagnosed my disease as ankylosing spondylitis. It primarily involved my back, hip joints, and, to a lesser extent, my neck and shoulders. He prescribed phenylbutazone, a nonsteroidal anti-inflammatory drug, to relieve my pain and stiffness, and it worked effectively.

Soon after I graduated from medical school in 1965, when I was 21, Pakistan was attacked by its neighbor, and I decided to enlist in the Pakistan Army Medical Corps. In my zeal to serve the nation in its hour of need—a nation that had accepted me …