Medicine

I recently read an online discussion about whether or not patients should have direct access to their own EKG.

W.S. Gilbert might have been writing about patients when he penned this lyric:

Things are seldom what they seem; 
Skim milk masquerades as cream.

I think there are some lessons to be learned from a recent scandal involving poor quality and safety failures at Stafford Hospital in England.

Over the last 44 years I have witnessed an unfortunate transformation in my chosen field of medicine.

Poor communication is the commonest cause of poor outcomes in medicine. Taking things for granted instead of asking questions is one form of poor communication.

Some of the things we learn during our medical training are startlingly obvious, but only after we have learned them.

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

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.