Tuesday, September 7, 2010

Grand Rounds: Musings of a Dinosaur

Grand Rounds is up at Musings of a Dinosaur. 

A few of my favourites:

She writes regularly on Huffington Post:

I know also, as a patient, that physical examination can be life-saving. Once, when I was in the hospital as a child and had unexplained fevers after surgery, it seemed for a while that no one could figure out what was wrong. I was terrified. The surgical team consulted with an infectious disease specialist, who as I recall ordered a whole bunch of unpleasant tests, and then my dad – a physician — noticed that one of my legs was more swollen than the other. He realized, based on my physical exam, that I might have a blood clot. It turned out that he was right.

So I agree that the physical exam is humanizing. So much so that, later in my career when I routinely donned space suit-like gowns and masks on rounds for the leukaemia and bone marrow transplant services, I became frustrated by those barriers, and by the very lack of touch which, I think, can help patients heal.

But what’s also true, in a practical and bottom-line sort of way, is that a good physical exam can help doctors figure out what’s wrong with patients. If physicians were more confident – better trained, and practiced — in their capacity to make diagnoses by physical exam, we could skip the costs and toxicity of count less x-rays, CT scans and other tests.

Recently I wrote a piece on medical education and going back to basics. The physical exam should be included, for sure.

In the meantime, I’ll leave you to read about bongi (the South African guy allergic to capital letters) and his adventures with, who else, the urologists.

He found himself the accidental assistant to the Professor of Urology. I will give you a taste of what real medicine is like in some parts of the world: (unedited)

"i think i have torn the ivc." he said it as if it wasn't a problem, as if it wasn't something that often was followed by the ending of life. i was amazed that he could be so calm when faced with such a calamity. and then i found out why. he looked at me.

"that's why you are here," he said, "it's your job to fix the ivc." he was calm when faced with such a calamity for the simple reason that he was not faced with such a calamity. i was. the realization set into my heart like a pick axe. i felt nauseous. i thought of that beer that i was busy not drinking because i was required to somehow perform a miracle on a patient that was never mine. but it didn't help to bemoan my position or to shy away from this immense responsibility that had been thrust upon me. i had to put my head down and fix it.

i fixed it. i remained calm on the outside and got to work and got the job done. but i think i shaved a few years off my life during that operation. when i was finished i was exhausted. i left the junior to close and finally went for that long overdue beer.

I just hope that in the future we still have doctors like “bongi”

Dr. Kimberly Manning, we get to end Grand Rounds with a grand slam home run of a post, beautifully written, Life at Grady, to Admit or not to Admit.

What I learned from this situation:
--When patients say that something "just isn't right", listen.
--When one part of the history is odd, like soiling your pants with blood, listen.
--Look at the whole picture.
--Recognize when you're in a position to advocate for a patient with just the stroke of an ink pen. --I still hate crack cocaine.
--Even though I hate crack cocaine, even those who use it deserve the benefit of the doubt.
--And most important, even when your patient uses crack cocaine, is homeless, missed his last appointment, and thinks differently from you...sometimes you just have to roll with it. Because many times the patient is, in fact, right.

Humanity, that is what medical practice is about: read the full post here>>>>

Then there is the one about Porsche:

Best Health Care: Private Medicine, Porsche & The NHS

1 comment:

Anonymous said...

"bongi" is amazing and he makes you proud to be a doctor.