Mea sententia

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.

It was January and there were several inches of fresh snow on the ground and no shoveled path to the car. The temperature in the teens. I had an errand to run with a child who INSISTED on going barefoot.  The following brief conversation between a seriously sleep deprived post-call parent and an articulate three year old. 

“Do you want to put your shoes on yourself, or do you want help?”

"I don't NEED to wear shoes. My feet aren't cold."

"They will be. It's cold out."

"My feet aren't cold."

"Put your shoes on."

"No."

"Fine."

The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients.

You know those newsy letters tucked into a card, a collection of headlines about a family's adventures since the last holiday season, often accompanied by a photo or two? 

Things are changing so fast that the Future happened last week and I missed it.

Titus Lucretius Carus (Lucretius) was born about 1 Century BC. His six part poem De Rerum Natura (On the Nature of Things) is 7400 lines of hexameter in the style of Virgil and Ovid mirroring Homer. His is hardly a household name, but when his work was (re)discovered and (re)published in 1417 by Poggio the Florentine it had major impact on the course of the Renaissance.

A recent conversation about an institution’s use of the A1c (a measurement of average blood glucose levels over the preceding 100 days) to grade clinician performance and adjust compensation frustrated me. The issue was the misunderstanding and misuse of surrogate markers, those things we measure when we can’t measure what we really want to know.