The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.
To most physicians, my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.
Veterinarians and Pediatricians (and Pediatric ER Physicians too)
I’ve always thought that veterinarians have it tough. They see patients who cannot communicate. Their patients don’t speak or complain of symptoms. So veterinarians have to go by what owners have observed and by the physical exam for most of their data.
It’s kind of like a pediatrician or even a Pediatric ER physician. Little kids might not be able to complain. And when they do, they may be very vague, unable to give a good description of what they are feeling.
I recently worked a Pediatric ER shift where I saw a 4 year old patient who was transferred from another facility. The other hospital wanted us to rule out appendicitis because the patient had abdominal pain and a CT scan that was equivocal.
I went in to see this little patient who appeared to be lying comfortably in the gurney watching the TV hanging on the wall. The patient, who I’ll call Joe, didn’t seem to be in pain. So I asked his parents what the problem was. It turns out that Joe had been vomiting — up to 10 times over night — and that was why he was brought in to the ED. I asked if Joe was communicative at home. His parents told me he was.
Was Joe a child who would normally complain of pain like a stomach ache? Yes, they told me. Did Joe ever complain that his stomach was hurting? No, he didn’t.
At this point appendicitis was getting knocked down lower on my differential (list of possible diagnoses). I proceeded to sit down next to Joe and say hello. He stared back at me. I told him I was going to just take a look at his stomach and started to pull back the hospital sheet that was covering his belly.
Almost immediately he pulled it back. Apparently, this kid liked his stomach covered up. I pulled back a little and pressed on his stomach. He started crying. I tried to observe how he was crying — to see if he was just being fussy or if it was really painful. I started pressing on the left side and worked my way to the right lower area of his abdomen (where appendicitis typically presents with pain) and tried to see if his crying intensified as I neared that spot.
I finally gave up and let him cover up his stomach. But I tried one more time. This time, I pressed on his stomach through the sheet. This time Joe did not cry. I was able to press fairly deep all over his stomach without eliciting any cries of pain.
That pretty much did it for me. And, after more discussion with the parents about Joe’s symptoms at home prior to coming in to the hospital, I concluded that appendicitis was not likely in this little patient.
In the adult world, most patients are able to communicate. Sure, I’ve had adults who were unable to communicate with me, but the proportion of patients who can’t communicate is much, much less. I don’t plan on going into pediatrics or emergency medicine. But I can appreciate how difficult it can be at times. And I am thankful that there are people who choose to do it.
Source: jeffreymd.com
Ad from Popular Science (March 1946 issue).
New JeffreyMD.com post: Doctors & Nurses
Unfortunately, it seems that many nurses have a bitter feeling towards doctors. I can’t say I know why. But only because I don’t know their perspective. I can only speculate. But I’d venture to guess that at the core, it is an issue of feeling unappreciated and disrespected by doctors. Those feelings can then easily turn into resentment….
Source: bit.ly
Medicine is a science of uncertainty, and an art of probability.
A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.
(via clocksanscraftsman)
Source: medicalstate
Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.
Something I’ve noticed
I always introduce myself as the medical student to hospital staff. To patients, I either say “medical student” or “student doctor” depending on the situation. And yes, sometimes my choice of wording is a strategic one.
But I have noticed that I’ve tired of correcting people who call me “doc” or “doctor.” I remember the first couple hundred times it happened I cringed. (I even cringed as a 1st year when I saw a 3rd year med student called “doctor” and she just acted like it was normal without correcting the patient.) I wasn’t the doctor. I even corrected a nurse once saying that I was “just the medical student.” I wondered if she just didn’t notice my short white coat.
But she said she knew. She also added that I would be a doctor soon. And she did it with a smile. Sometimes the nurses can be so motherly and encouraging that I just want to hug them. I’ll withhold my comments about the other kinds of nurses I run into as it is still national nurses week.
I also have been called “doctor” by hospital staff who walk by me and say excuse me, or ask me if I need any help (cause as usual, I’m looking lost), or are just being friendly and saying hello in the elevator.
So now I still introduce myself like I’m supposed to. After all, its a legal thing as well. But if people still choose to call me “doctor,” then oh well. I’m tired of caring about it.
I'm Not One Of Those Fancy College-Educated Doctors
I’m a doctor, and I’m damn good at it. Why? Because I learned to be a doctor the old-fashioned way: gumption, elbow grease, and trial and error. I’m not one of these blowhards in a white coat who’ll wear your ears out with 10 hours of mumbo-jumbo technical jargon about “diagnosis” this and “prognosis” that, just because he loves the sound of his own voice. No sir. I just get the job done.
….
You want to know where I got my doctor’s degree? At the Medical School of Hard Knocks, that’s where. No matter what they say, advanced graduate studies won’t teach you when somebody needs a shot of whiskey. Yale and Harvard don’t tell you when to throw a bucket of water on a patient. And they can never teach you how to tell when someone just needs a good solid punch in the nose to bring them around.
…
Jesus, you ever look at one of those scans? They’re just a lot of crazy shapes. The only sure-fire method for figuring out what’s inside a man’s body is to go in there and take a look for yourself. And if you want to put a shunt or a valve into a person, you don’t rely on gimmicks like tubes and syringes. You get your hands a little dirty, you open them up, and shove it right in there where it belongs.
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