Mea sententia

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

I recently received an email from my employer, with a link and a request to fill out a short survey evaluating a new service available to our patients. I had a brief gap between patients, so I clicked and did the six questions. As I hit submit, it occurred to me that the survey seemed familiar. Hmmm. Looking back in my older emails, I found that I had received a similar request from the same group about 2 weeks earlier, with the same link. I contacted the person who had sent the second email.

The scientific method has given us modern medicine, with astounding abilities to diagnose, treat and even cure. Until the last century, medical treatment was futile at best and fatal at worst. Cure was not possible and the touchstone of our profession was comforting the patient. 

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.