Mea sententia

Evidence Based Medicine (EBM) is a relatively recent but very popular development with great potential for both good and ill.

It was my day to see ‘acutes’ - patients who call with issues that need to be seen that day. A day to be prepared for anything.

The language of medicine is highly evolved and complex and allows clear, detailed, specific and unambiguous descriptions. Except when it’s not.

When I saw Josh on my morning schedule for a college physical, I was surprised. Pleased, but nonetheless surprised. Josh was a good kid with a quick intelligence for things he could touch or build, who always made it clear he didn’t care for school, but who had never been in academic difficulty, getting by with mostly Cs and occasional Bs. He worked some in his uncle’s electrician’s business, and I had always thought this was a good match for him. College was something he had never expressed interest in.

I have been blogging at PeterEliasMD.com for almost 6 months and have learned a great deal.

Today’s mail included a note from a grateful mom and dad. It had a vintage car on the cover, and the message made me smile:

Many organizations talk about and attempt to use quality improvement management tools, such as those drawn from the Toyota TQM, Lean, and other recent popular management paradigms. 

I’d been seeing Derek for just under a year. He was 29 and told me he had moved here from Oklahoma to help care for his aunt when she was diagnosed with cancer. He was not married but had a child ‘back home’ in Oklahoma, about whose mother, a former girl friend, he had nothing good to say. He came with a thick stack of records and several disks with MRIs, which told a history of a fall at work resulting in severe back pain with radicular symptoms (pain and some numbness into his right foot and little toe).

Beginning at least as early as the pre-Socratic era around 6 centuries BCE, it was assumed that the earth (and therefore humanity) stood at the center of the universe. It was all about us - and only about us. 

Bob was 18, a high school senior, a good student, played soccer and ran track, excelling at the 400. He was in the office with his mother to follow up after an ED visit and brief hospital stay earlier in the week. The discharge sheet they brought in noted that he had responded promptly to treatment for a viral illness with vomiting, diarrhea and dehydration (VDD), but because of an unexplained tachycardia he was advised to be seen ASAP to obtain a referral for cardiac evaluation.