Lessons from Oliver Sacks

The art of appreciating each patient’s uniqueness

An inspirational figure in my journey to becoming a neurologist died on 30 August 2015. I have been reflecting on what I have learned from the writings of Oliver Sacks over the course of my career. Many of these lessons apply to medicine more generally.

For me, the greatest lesson is that all patients are interesting. But more than that: Sacks was gifted at being able to transform patients’ everyday stories into fascinating stories with lessons for us all. Sacks was a humanistic doctor who ensured that patients held centre stage in his accounts of individual stories. In an age when doctors are sometimes more concerned with making an unusual diagnosis, Sacks was unique in conveying accounts of patients and their lives to a wider audience. In contrast to doctor-centric writers, Sacks was able to make a number of astute observations of his patients in a colourful and amusing way that will continue to be remembered down the generations.

Many of the patients I see do not have something “neurologically sinister” going on. However, many of us focus on what we consider our domain of practice and take some pleasure in diagnosing and treating conditions with which we feel comfortable. We want to address the “real” patients — the ones who have something seriously wrong and the ones for whom we can make a real difference.

Sacks approached neurology with curiosity. For most of the patients he saw, there was very little that could be done if that is understood in terms of giving them a medication to help “fix” their condition. Sacks was driven by a quest to understand the behavioural and neuropsychological manifestations of various neurological conditions.

Sacks’s greatest achievement, in my view, was his ability to formulate an integrated understanding of a patient’s neurological condition and how it intersected with his or her day-to-day life. Very simply, Sacks was able to appreciate that neurological conditions do not simply exist in the brain but rather are embedded in the very fabric of our societies. We all live in a social matrix. Sacks articulated stories about patients and how their conditions informed their daily struggles.

Many of us focus on diagnosing a particular condition. Sacks’s contribution was very different because he would focus on everyday stories which went beyond a diagnosis. Sacks saw some pretty rare cases but he describes more common cases in unique ways.

Sacks taught me to learn from each of my patients. That is, all patients, no matter who they are, have untold stories. If we can provide a clinical environment in which patients feel comfortable to inform us about their lives and the meaning of their various medical conditions, then we are half way towards treating a patient, but even more importantly, treating a patient as a person who is often a part of a family unit, culture and society, and a citizen of the world. Ultimately, this enables us to provide the best care for that person.

I am not saying that I can practice everything that Sacks has taught me. But each time I pick up a patient’s chart, I try to think that my job is to see the patient holistically.

So next time I see a patient, I may pretend that I am Oliver Sacks and ask myself: what can I learn, not from the patient but rather from the person seeking help? Each person is the product of developmental and evolutionary history spanning millions of years through a process we really do not understand. Each person may or may not have a sinister neurological or medical problem, but each has a story, a narrative waiting to be told.

To achieve what Sacks did, we need to be open and listen to each story. For me, that’s the take-home lesson from Oliver Sacks: see if you can uncover the untold story, because once elicited, the story has a life of its own and we all stand to learn.