When the Doctor Isn’t the Only Expert: Finding Wisdom in Patients

“I was so much older then, I’m younger than that now.” ––Bob Dylan, My Back Pages

Let’s be honest—doctors wonder why patients often don’t seem to follow the most current, evidence-based advice they work so hard to deliver. They have studied, trained, and stayed up to date, but people still make choices that don’t always seem right.

In my nearly 40 years as a family doctor and hospice practitioner, I wondered about this a lot. I know other doctors have too. It’s frustrating when patients don’t listen, and things turn out badly. It can be stressful, make us angry, and leave us feeling helpless. Over time, it can even burn us out.

But I’ve learned that sometimes the best wisdom comes from the patient, not the doctor.

As doctors, we’re trained to be the experts. Patients come to us for answers, and we aim to offer the “right” options and to fix disease. We are schooled to make the correct diagnosis, prescribe treatments, to cure, and return a person to a normal state. But over time, I’ve come to understand that the best answers don’t always come from us. While our training and experience is good and necessary, it is not designed to fully embrace the wisdom of the patient, their lived experience, and their community of support.

In Cancer Consultation: A Patient Artfully Tutors an Oncologist, a doctor shares a story about a patient with advanced, stage 4 colon cancer. The doctor thought he did everything right—he explained the treatment options, laid out the pros and cons, and didn’t pressure. He felt like he’d done a good job with sensitivity and compassion.

But a week later, the patient sent a letter that started, “Dear Doctor, thank you for your time. You are very knowledgeable.” It included a carefully hand-copied poem written by Thomas Moore from over a century ago about fading memories, loneliness, and what someone finds important as their life sunsets. He shared that he planned to return to his homeland and be buried near his ancestors and an old love from his youth. That was the one option they had not really discussed.

Looking back, the doctor realized he’d missed something important. He thought the patient only wanted treatment options, but the patient had other concerns that the doctor hadn’t even thought to ask about or listen for.  The poem was the patient’s way of gently educating, of saying, “There’s more to my story than just the cancer.”

Reflecting on this experience when he was much younger, the doctor said, “I’m grateful that this retired laborer thought I was worth the tutoring. I like to think it was effective.”

The truth is the wisdom to make good choices is often already with the patient. We talk about “shared decision-making” in medicine, but it’s not always easy. At the Journey Guide Project (JGP), we help patients become experts in their own stories. And we help practitioners learn to listen more, step back, and see that their knowledge is only part of the whole picture.

It’s not easy, though. The system often pushes for clear answers, even when things are uncertain, and values numbers more than personal stories.

So maybe the real lesson here is that being a great practitioner isn’t just about having the right answers—it’s about asking the right questions and helping patient’s lead with their own story.