Mea sententia

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.

Eczema had been her only real health problem, but what a problem it had been. 

Winter is coming, and with it – snow. Some of us love it and some of us hate it. And some study it. Read this story about the life and work of Wilson Bentley, a self-educated farmer from a small American town who, by combining a bellows camera with a microscope, managed to photograph the dizzyingly intricate and diverse structures of the snow crystal.

As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let alone occasionally heal. It has been - and continues to be - a glorious and fulfilling career. But it has not been easy or without pain, confusion, fear, or despair.

I am thankful for it all, both the bad and the good. For all the things that make the world what it is. I am thankful for the opportunity to participate, to try to make a difference.  And I wish you all the best holiday you can have and the opportunity to be thankful, too.

There are limits in both music and medicine. Go beyond those limits, and disaster is inevitable.