It's not always about pills

Today I was reminded that medicine is not entirely about pills, and not entirely about sickness. I was in the cardiology clinic, wrapping up a patient encounter with my attending. It hadn't been a difficult one, the guy is pretty healthy, and was only in the clinic because of a scare over an abnormal EKG, which he had only gotten because he was participating in a study. He works in one of the clinics downstairs, and this was his follow-up appointment. Asymptomatic sinus arrhythmia, not going to bother him. He had managed to stop drinking alcohol, which had been recommended the last time he was in and his only request was to get the nicotine patch. But Dr. Woodley did something quite interesting. Their conversation went as follows:

"I think you can stop smoking on your own. But what is really important is that you leave here and improve yourself. Go out an get an education. The military will pay for it, go get a degree"

"I know, I'm trying, but night classes are hard"

"Yes, thank you for reminding me that life is hard. Go get an education, and don't come back here unless it is to brag to me. I'd love to see you for that purpose"

Later that day, Dr. Woodley was telling me how to take a history (a favorite subject for attendings talking to med students) and he mentioned that the most important part of the history was the social history. This surprised me. More important than knowing about chest pain, dyspnea on exertion, past medical history, surgical history or anything, is knowing whether a patient is married, whether they have kids, whether they smoke, drink, have any hobbies, go to church, etc. Amazing.

This evening I was telling a friend how interconnected the cardiac system is. How the heart is affected by the kidneys, by the liver, by the lungs, by the brain. Cardiology then, (like most of medicine but perhaps more so) requires a knowledge of every part of the body and how they affect the system of primary concern. And the holistic approach evinced by Dr. Woodley's advice shows that far reaching concern.

Finally, Dr. Woodley said something which sounds at first like a compliment, but is more a statement of philosophy. He said "What's the best thing to happen to medicine? You are. Never forget that."