My blog represents my personal experiences and perspectives. This includes many anecdotes from my life and from my medical practice. I have been scrupulous to anonymize all medical anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)
Darwin observed: “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” This profound observation is poorly understood and usually ignored by institutions and organizations.
Evidence based medicine has much to offer, but one has to remember Einstein’s famous remark: “Not everything that counts can be counted, and not everything that can be counted, counts.”
It was about 2:30 am when the phone rang, waking me from the deepest and best part of sleep. It was the answering service, and they patched my patient through.
Me: (Still groggy, trying to wake up.) “Dr Elias here, on call for Family Health. What’s the problem and how can I help?”
Female voice: “I can’t sleep.”
pause…
Osler, often referred to as the Father of Modern Medicine famously said: "If you listen carefully to the patient, they will tell you the diagnosis.” He emphasized both the value of a careful history in medical diagnosis and the value of learning from one’s patients. Ask any practicing clinician and they will have anecdotes that illustrate how right he was. One stands out for me.
In 2004, Dr. Lawrence Huntoon wrote an editorial (in the Journal of American Physicians and Surgeons Volume 9 Number 3 Fall 2004) expressing concern about the potential abuse of ‘disruptive physician’ clauses being added to many medical staff Bylaws. Below the fold is my updated version of the poem (Memo to the Disruptive Physician) included in his editorial.
Memo to the Disruptive Physician
Sometimes the health care system just does not work.
Over my three plus decades of primary care, I’ve come across some strange folk remedies. Most have a kernel of truth, or at least, a plausible origin. Some have fascinating ethic components. Some are harder to understand. And some…well, you decide.
It was January and there were several inches of fresh snow on the ground and no shoveled path to the car. The temperature in the teens. I had an errand to run with a child who INSISTED on going barefoot. The following brief conversation between a seriously sleep deprived post-call parent and an articulate three year old.
“Do you want to put your shoes on yourself, or do you want help?”
"I don't NEED to wear shoes. My feet aren't cold."
"They will be. It's cold out."
"My feet aren't cold."
"Put your shoes on."
"No."
"Fine."
The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients.
You know those newsy letters tucked into a card, a collection of headlines about a family's adventures since the last holiday season, often accompanied by a photo or two?