MEDICAL MATTERS/Dr Muiris Houston: Regular readers of this column will be aware of the importance I attach to the stories that patients tell doctors.
With an ever-increasing trend towards high tech medicine, it is important that we don't lose sight of the patient's own narrative, and in the process devalue the age-old ability of doctors to make a diagnosis based on each patient's unique story.
Last week's British Medical Journal had an interesting report about how little time it actually takes a family doctor to allow a patient complete their "presenting" story at the beginning of a consultation.
There has been some concern that such stories were being interrupted because of mounting time pressures on doctors.
The Israeli researchers found that twice as many patient narratives were completed after doctors were given a written note prior to the consultation that said: "When the patient starts speaking, please do not interrupt him or her until you are satisfied that he or she has finished."
Prior to the intervention, the time taken for patients' initial stories averaged 26 seconds; after the reminder they lasted 28 seconds.
The researchers concluded, "allowing patients to complete their monologue requires little time and does not disrupt the other components of the clinical encounter".
When someone begins the final journey from this life, listening to their story becomes even more important for all kinds of reason: there may not be a lot of time left; there may be a lot of "business" to get through - the settling of affairs, saying goodbyes and achieving short-term goals.
For a healthcare professional to miss subtle clues at this time can have unfortunate consequences.
Of the many people whom I have had the privilege to look after when they were dying, just one kept a diary of the process. As you can imagine, I was deeply touched when his family gave it to me to fulfil one of his dying wishes.
Which brings me to a recently published book, Excerpts from a Family Medical Dictionary, by the established American writer Rebecca Brown.
In 1997, her mother Barbara became ill with cancer. The book traces the slow, gradual erosion of her mother's health.
Here is an excerpt from a chapter entitled "Unction: the art of anointing". It describes the period immediately after Barbara died.
"My mother's body was covered with sweat. We'd been changing her sheets and the night shirt she was wearing several times a day, but she'd break into sweats as we changed them. Sweat would pour down her body. I didn't know how she could have so much when she hadn't been able to drink at all for days.
"We washed my mother with warm, clean, sweet smelling water. I remember the bowl with the water in it, and my sister and Chris and I each dipping our hands in it, or our hands and a cloth, into the bowl, then washing my mother's skin. We took turns holding the bowl and took turns washing.
"Her body was hairless as a girl and it was smaller. She'd lost so much weight and her skin was loose. But when we washed her, lifting her hand, her arm, her foot, her neck, she gave to us. The tension in her body, how it was stiff and clenched and could not bend or be turned easily the last days of her life, the twitching and the rigidness her body had had for days, had been released.
"The doctors and the hospice workers had said she was past feeling, that the twitches and groans that came from her were involuntary.
"Her brain stem was only functioning at the very lowest level, to make her lungs breath and her blood circulate. They told us she was not aware and that her body could not feel anything.
"But it was hard to see her twitch, and hear her throat and mouth make noises that sounded almost human, almost like speech, as if she was trying to tell or ask or beg us for something, for mercy perhaps.
"We washed our mother's body and we talked to her. Her body was limp and we washed her slowly and tenderly, as if she could still feel us, or feel us again. We washed her skin and told her that we loved her and we'd remember her. We thanked her for her life, for being good to us and kind. We told her that her body's pain was over. We told her we'd take care of things. She'd worried about things when she was alive, that she had left a burner on or hadn't locked a door. She worried about her children, if we'd eaten enough or were warm and safe and if we felt cared about and loved. We told her everything was fine, that things were taken care of, that she could rest."
This moving book would help anyone who is living through the dying process with a close relative. And it certainly emphasises the importance of the patient's story.
Excerpts From A Family Medical Dictionary Rebecca Brown, Granta Books - £10 sterling. Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie - He regrets he cannot answer individual medical queries.