RAMB 07/07/2014

7 / 102

Haddad LA et al.
188 Rev Assoc Med Bras 2014; 60(3):188-189
COrrespondence
The Baudelaire phenomenon
O fenômeno Baudelaire
José Baddini-Martinez*
Associate Professor, Department of Clinical Practice Medicine School of Ribeirão Preto, University of São Paulo
*Correspondence:
Address: Avenida Bandeirantes, 3900
Campus Universitário
ZIP Code: 14048-900
Ribeirão Preto, SP, Brazil
Email:
In recent times, we see patients who consult numerous
doctors in a short time, and do not obtain definitive diag-
noses, or effective therapies, ending up increasing their
doubts, insecurities, dissatisfactions, and piles of supple-
mentary tests. Despite the fact that this “low resolution
medicine” affects more often users of the national public
health system (SUS), it also exists in private medical care.
The “Way of Sorrows” experienced by patients has mul-
tiple causes, most of them outside the range of influen-
ce of physicians. But to what extent they can contribute
to the events described? We propose the name “Baudelai-
re Phenomenon” for situations of this nature that can be
attributed more to the behavior of doctors than the weak-
nesses of health systems.
The Baudelaire brothers are characters from children’s
literature, protagonists of the A Series of Unfortunate Events
collection, written by Lemony Snicket.1 The three orphans,
despite their inherited fortune, experience great difficulty
in getting a suitable tutor, constantly moving from one
place to another. The resemblance to the facts described
above is evident. Some patients, despite paying substan-
tially for medical consultations, feel orphaned in relation
to care and in need of explanation about their actual
health status.
It is likely that the reasons for the Baudelaire Pheno-
menon are multiple. Listed below are some causes that
may act alone or combined:
• • Agnosia of the specialist: some doctors simply can-
not see beyond their own specialty. As a consequen-
ce, they are blinded to the whole, that is, they are
incapable of developing comprehensive clinical rea-
soning.
• • Pilate complex: once they discard diagnoses within
their specialties, some doctors declare that their job
is done, guiding patients to seek experts in other areas.
They show no actual interest in contributing to the
conclusion of the case. A variation of this complex is
that in which the patient is seen as connected to a
health plan or public health system, rather than con-
sidered as a human being seeking his or her doctor
and who expects proper care and guidance.
• • Diabetic formation: as if they had diabetic neuro-
pathy, some doctors are insensitive to the suffering
of patients. Although this evil can arise only after
years of work, medical courses have failed to de-
velop the skill of empathy in students. In other si-
tuations, the further exploration of glaring mista-
kes committed by colleagues ultimately proves
extensive training failures, as in the case of diabe-
tic feet.
• • Banking hours syndrome: some physicians want
to maintain their connection with patients only
during business hours.
• • Videogame doctors: some doctors are more fasci-
nated by the images of examinations than by the
actual human beings. Often, these professionals
have difficulties to interpret test results within the
appropriate clinical context.
• • Spraying of responsibilities: when patients are seen
by multiple physicians simultaneously, and ever-
yone can happen to think that talking to the pa-
tient and family is a responsibility of the others.
Prophylaxis of Baudelaire Phenomenon includes techni-
cal and humanistic education of students in medical
schools, and constant self-vigilance in order not to fall in
the behavioral traps identified. When a patient is being
treated by many doctors is important to point clearly who
will be primarily responsible for communicating with the
patient and family.