Monday, January 09, 2006

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."

2 comments:

MrStandfast said...

First off, I like the way you write, and I'm a litle jealous of the energy of your voice. Mine is so weary these days...see below for confirmation. But

What do I want to say. I want to be the perpetual johnny rain cloud I have grown into lately. I, the bottom fish, the great leech, the lamprey, the collosal vacuum of joy and wonder, want to say something cold hard and real. Why. I resent real. I am peeved at the real for being real. I read science fiction. I love science fiction. I write science fiction. I think though, that I do it because as much as I resent the real, I love the real because I know it is real, and no amount of resentment can make it less real. Here's my drizzle. It's also a sneak peek at my book so if you plagiarize I'm going to sue your medical socks off.

Kidding.

People always want to find metaphors for their jobs, as though what they do is not enough. They want their job to mean something else. I guess I'm wondering if maybe your job is in fact just about healing, and not about the other things. Doctors should heal, should prescribe medicine form expertise. I don't want them to solve the world's problems on the back of envelopes. I want them to heal.

People want their jobs to connect them to something grander, they want them bigger, they want them to be philosophy. Mine is not. I will not tell you my job is more than it is. I assess broken things. I put a value to them. Someone's photographs are destroyed. When I am there...they're not memories. They're paper. It's sad, but it's real.

MrStandfast said...

Also...I apologize for the typos. Blogspot innexplicably cut out three or four sentences from my post though. Weird.