Wednesday, November 08, 2006

Consult Cards

I'm doing consult cardiology right now, and overall, I love it. Cardiology, or "cards" as it is referred to occasionally, is an amazing specialty. If you liked physics, or math, because "it just made sense," you'd love cardiology. It is far and away the most scientific of the branches of medicine, in that it takes evidence based medicine very seriously. Every point has to be proved. For example, even knowing nothing about physiology, you'd probably guess that someone with "inducible arrhythmias and heart failure" is worse off than someone with "heart failure alone", right? Well, cardiologists felt compelled to prove that, in a trial called MADIT 1. That's the other quirk of this specialty, all the important studies seem to be named. MADIT, CONSENSUS, AFFIRM, ISIS... the list goes on for ever. There are over 2000 named trials.

But I am being sidetracked. The intricacies of cardiology are not my point here, interesting as they may be. What I wanted to say was the oddity I've noticed with consult medicine. As a specialist, you are consulted to see patients you don't need to follow closely. You are concerned with one problem, or at least, one organ system. And so the connection with the patient is not as strong as from the primary team. So I see dozens of patients, but have difficulty remembering names. I see a slice of who they are, but I'm being forced to consider only one organ system, and the others only as they relate to that system. It keeps the patient at arms length in a sense. I'm fairly sure I don't like that.

The good news is that no specialty is entirely consults, as far as I know. It is also possible to see clinic, and have your own patients, in all of the medicine subspecialties. So, while cards remains at the top of my list of favorites, sober judgement (and review of my grades) is causing me to keep my options open. We'll see.

1 comment:

MrStandfast said...

A year ago, I thought essentially that I would remember every face and name and quirk of people I meet on the job. I think the eventual curse of any position where you've got a detailed job to do, but you essentially work with people and problems, is that you do forget. That's why I wrote my book in part. The more I wrote down stories of people who answered doors with guns, or didn't wear pants while I talked to them, the more I remembered things like what the hooker was wearing when she tried to seduce me. And the less I had to remember for later...because it was all written down now. Anyway, I mean I used to keep something like a catalogue of faces and personalities, but it's just not possible, unless you're william mckinley's reincarnated scion, to remember everyone. The best you can do is to engage people in the moment. Then again that's especially hard to do when (in both of our jobs) you're essentially dealing with traumatic problems. What I always tell people when I interview for jobs, and the inevitable "how do you deal with difficult people" question arises (they ask that for all the jobs I am looking at...which ought to tell you something about the lines of work I am pursuing) the answer I've sort of decided on, and one I believe in, is that I try to address the problem and not the person's attitude.

All this is I guess to say that you can't expect to remember everyone, you won't, and that's alright. You just treat people like people, problems like problems, and screaming irate lunatics who tell you to, and a I quote "Go f#$% yourself you f##$ing incompetant little bastard" like foul mouthed lego in just address the issue at hand and not whether I might actually be all the things she swears I am, or why she might think that.