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On Being a Doctor |

Lessons from a Label Maker

Y. Pritham Raj, MD
[+] Article, Author, and Disclosure Information

From Duke University Medical Center, Durham, NC 27710.

Requests for Single Reprints: Y. Pritham Raj, Duke University Medical Center, Box 3369, Erwin Road, Durham, NC 27710; e-mail, raj00002@mc.duke.edu.

Ann Intern Med. 2005;143(9):686-687. doi:10.7326/0003-4819-143-9-200511010-00013
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Transitional objects are ubiquitous in childhood. They may take the form of a favorite blanket or, in my 18-month-old son's case, a stuffed bear named Bo. Mine was, oddly enough, a label maker. It was a lime green contraption with a circular head that would imprint anything I desired onto small strips of plastic. It was housed together with my other treasures—battered toy cars, little green army men, and assorted charms from cereal boxes—inside a small canvas bag with a drawstring top that, when slung over my shoulder, gave me the look of a miniature hobo. I loved that label maker. More than a transitional object, it was a companion that followed me into adolescence.





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Insurance and Labelling
Posted on November 10, 2005
Jayaram S Bharadwaj
Sac-Osage Hospital
Conflict of Interest: None Declared

Labelling can have significant adverse event in how insurance companies determine an individuals insurability. With genetic testing being so easily available, many practically insignificant carrier states could be diagnosed with repercussion on patients insurability. Recently, someone close to me was found to have new onset Diabetes Mellitus, and also had recurrent leg ulcers from Swimming pool granuloma. Despite the leg ulcer healed from appropriate therapy, they had to be labeled "granulomatos leg ulcer of uncertain etiology" as the cultures were repeatedly negative. Life insurance companies put these two diagnosis together, Diabetes Mellitus with recurrent leg ulcers and declined life insurance repeatedly.

Another of my colleague recently informed, at a meeting, that one of his patient was upset with him about a labeling he had done almost 2 decades ago. She makes it clear about this feeling, each time she sees him. We suggested he should be happy, that patient still sees him in clinic. He immediately said "I never told she sees me in the clinic, but elsewhere in supermarket, gas station etc".

Conflict of Interest:

None declared

Labeling creates more victims
Posted on November 15, 2005
Kuldip Parkash Anand
Command Hospital (EC), Kolkata 700027 India
Conflict of Interest: None Declared

Dear Sir,

We read the moving piece "˜ Lessons from a label maker' by Dr.Raj (1). It is a simple, honest and thought provoking article which helps us in understanding cryptic mysteries of human behavior. Are we all not victims of labeling based upon religion, culture, color of skin, language and geography decided by arbitrary man made lines?

People are labeled Christian, Muslim, Hindu, Buddhist; poor, rich; fair, dark; ugly, and beautiful routinely. History tells us that we seem to have been more harmed than benefited by all such labels. Dr.Raj's mother's advice to be careful and judicious while attaching labels has a much deeper wisdom. Howsoever good the label may be; it will always have a gummy undersurface which will leave some dirty mark. We in Armed forces have seen many careers getting ruined , many promotions getting denied and many lives being made unhappy and miserable because of over zealous and indiscriminate labeling. Even some labels like hypertension, diabetes, bronchial asthma which appear simple and harmless in civil life are not all that innocuous in Armed Forces life. Sometimes deliberate wrong labeling as an act of kindness may be prudent if it does not harm anybody.

Conflict of Interest-none Source of funding-nil

Sincerely Professor Kuldip Parkash Anand MD Professor and Head Department of Medicine Command Hospital (Eastern Command) Kolkata 700 027 India

Ajit Singh Kashyap MD Command Hospital (Southern Command) Pune 411 040 India

Surekha Kashyap M DCommand Hospital (Southern Command) Pune 411 040 India

References 1. Raj YP. Lessons from a label maker. Ann Int Med 2005;143(9):686-87.

Conflict of Interest:

None declared

No Title
Posted on November 14, 2005
Gary H. Oberlender
Univ of Virginia
Conflict of Interest: None Declared

November 9, 2005

To the Editor:

Dr. Raj's essay, Lessons from a Label Maker (Ann Intern Med. 2005; 143: 686-687), accurately portrayed the emotions involved in delivering bad news in the form of a serious medical diagnosis, which can evoke powerful emotions for both patient and physician.

But the essay also reminded me of what has become one of the most pleasurable parts of my work as an internist/geriatrician. That pleasure is the occasional jackpot one hits by deciding to challenge an ominous diagnostic label and uncovering an alternate, and treatable, explanation for a patient's symptoms.

Among the many elders diagnosed and labeled as having Alzheimer's disease, one will often find patients whose cognitive and/or functional impairment is in part attributable to a previously undiagnosed depressive disorder. Treating the depression can bring about significant functional improvement for many of these patients. Much less frequently, a patient will turn out to have depression, or sometimes the untoward effects of a medication, as the sole cause of their cognitive and functional impairments. The sense of accomplishment and service one feels with such a discovery is highly gratifying, a different variety of powerful emotion. Although some of these patients have had subtle red flags buried in their history, physical exam, lab results, or imaging studies, my decision to critically re-evaluate or repeat elements of what otherwise appears to be a thorough diagnostic evaluation is usually based on an intuitive feeling that something doesn't fit.

As Dr. Raj pointed out, diagnostic labels can certainly become double -edged swords. Perhaps we can dull one of those edges by remembering to maintain a healthy skepticism before accepting diagnoses that just don't feel right.

Respectfully submitted,

Gary H. Oberlender, MD, FACP

Conflict of Interest:

None declared

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