Rachel called about her elderly father, Blaine, better known to me as Bucky. She requested a ‘nerve pill’ to calm him down at night and a referral to a neurologist to test for dementia.
Trust but verify (Doveryai no Proveryai) is a Russian proverb that underlies an important principle in medicine. We need to trust our patients, our tests and our knowledge - but must also always remember to check and verify.
One has to ask the right question in order to get the answer.
The chief complaint on the encounter form said ‘panic attack’ and a quick review of the chart before I entered the room showed a healthy 28 year old woman with no health or emotional issues who came in every year for a routine birth control visit. She told me she had had a ‘panic attack’ the day before and was sure there was nothing serious wrong, but came in at the insistence of a colleague. “It’s probably a waste of time, but Seeley made me promise to come.”
Eczema had been her only real health problem, but what a problem it had been.
The Grand Rounds presentation that week was in the form of a Clinical Pathological Conference (CPC), a medical tradition where a case is presented to an expert or panel of experts in front of an audience of clinicians. The presentation is usually done in the order the information became available during the patient’s hospital course and the experts ask questions, discuss what they think is going on and why, are given more data based on the questions they ask, and ultimately try to come to the diagnosis that was proved at surgery or autopsy.
Every year, as winter approaches, I look forward to big snowstorms. Not just because I love Nordic skiing - though I do. Not just because the individually tiny flakes and their accumulation into deceptively gentle drifts are such a useful reminder of the importance of soft power. Not just because of the quiet, or the magic of moonlight glistening on fresh powder, or even the knowledge that the piles of snow against the foundation will help insulate the basement and protect our pipes.