Dr Curmudgeon is showing her softer side today, with some words of wisdom for new physicians.
Lest We Forget:
Medicine is not about entering useless data into a computer
Medicine is not about seeing a patient within a designated number of minutes
Medicine is not about redirecting the conversation when someone wants to proudly mention his granddaughter who just got her Ph.D.
Medicine is not about pawning off a solid history to an intake form
Medicine is not about sloughing off history taking to a nurse.
Medicine is not about staring at a computer rather than our patient
In the beginning, we were all taught to observe the patient, to watch as the patient walked. Was he stooped over? Did she need to use accessory muscles of respiration to breathe? Are his fingers clubbed and tobacco stained? Do her eyes deviate to one side as she slowly answers “no.” to a question. Was this really a “yes” that she was uncomfortable admitting? Did that hesitatingly said “no” mean that his rectal bleeding only happened once in a while?
We were taught to listen, to watch facial expressions, to hear voice changes with responses, watch physical movements as we focused on our patient.
At that moment in time… as we sit with our patient, there is nothing more important than the human being who places his trust in us.
It is not about:
- Getting data into an EMR,
- Being sure a scribe took down important facts,
- Counting the minutes we spend.
It is about listening, observing, allowing the patient to let us know about her recent problem with a child, the difficulty of working more physical activity into her life, how stressful his job has become.
After really hearing the patient, we learned to do a complete physical exam, to lay hands upon our patient, to seek out places of tenderness or organ enlargement.
And we swore oaths to teach, to impart knowledge and skill, to share what we have learned.
One of my greatest joys has been the opportunity to mentor students in my office. They learn from me. And I learn from them. I teach them more than history taking and physical diagnosis. They absorb my love of being a Physician. They begin to understand that we have to work within the patient’s way of life. A working mother, on a limited income, cannot afford the expense and time to go to a gym. And so we talk with her and learn that she loves to dance. We find out that in the evening, with her child asleep , she can turn on music and dance. This is movement. This is exercise.
So many little things we do that are not really taught in school. The most recent was a student who was surprised to learn of how I usually handled negative study results. If they come in, late on a Friday afternoon, I don’t call the patient. I call if I know that the patient wants the results immediately or if the patient has called me.
Because I have a relationship with a specific patient, I know that is better for him if I wait until Monday to discuss the result. After we review the study, we can promptly set a path to deal with it, what we do next, what specialists should be called in. We can take immediate action, rather than letting him worry all weekend.
My patient’s focus is redirected from the less than happy result and he can take charge, get in control of the situation without any weekend delay of nothing to do but worry.
Medicine is more than a skill that is taught, it is truly an Art and one must be in love with medicine to be able to do their best.
We will continue to discuss topics like this on SERMO. If you are an M.D. or D.O. in the US or UK, please join us.
Doctor Curmudgeon is Diane Batshaw Eisman MD, FAAFP, a Family Physician, writer, voiceover artist, and medical educator. It was in the Neolithic Era that the doctor became renowned for expertise in Trephination. After so much time in practice, Doctor Curmudgeon is now cranky and has rightfully earned the honorific of “Curmudgeon.”
Doctor Curmudgeon has no idea of what will appear in this space. It depends on the Good Doctor’s mood and whatever shamans and doctors are channeled at the moment.
As a curmudgeon, I may stray from what I observe happening in medicine and slink into other areas. But that is the prerogative of a Curmudgeon. Please check out my first book, “No Such Agency.”