my life, my pace

My little bout with cellulitis left me so bored that I finally got around to finishing How Doctors Think, a book by Jerome Groopman that got quite a bit of press when it came out a couple of months ago.  It’s a pretty easy read, but it was full of things I had never really thought about before.  For example, we know that we often make assumptions about people because of the way they look or act.  The disheveled guy who shows up at the ER must be a transient looking for a place to sleep.  And it makes sense that doctors and nurses often make these same assumptions when they treat these patients.  What I didn’t really consider is that we also make the opposite assumptions about healthy-looking people; that is, when we see someone who looks fit as a god and who we learn exercises and eats right, we tend to think that they can’t possibly have heart disease and aren’t on full alert when we’re examining them and ordering tests, leading us to possibly miss the diagnosis.  There are also good examples of how doctors can get into a one-track-mind kind of mode once they’ve latched onto a diagnosis that makes sense to them.  All in all, I would recommend this book to medical students and patients alike.  Medical students can become aware of the errors in thinking that doctors can make that they don’t really teach in medical school.  Patients can use this book to learn how to be more proactive in their care–in fact, he gives specific examples of the kinds of questions patients can ask to help steer their doctors away from some of the common mental traps that exist in medicine.

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1. so now we’re doctors?Before we even started our classes, we participated in the White Coat Ceremony in which each entering student is presented with a white coat (a short one, mind you…we’re not quite doctors yet and they don’t want anyone mistaking us for doctors and neither do we). Somehow, they expect that putting on this white coat will magically transform a bunch of not-so-long-ago immature college graduates into responsible doctors-to-be. I felt more than a little silly in mine, as if I were trying to pretend to be someone I’m not (at least not yet). The fact that they don’t make white coats small enough for petite little me also didn’t help. I’ve worn it many times since to go to clinics and preceptorships, but I still feel like such a poseur in it. I still feel horribly inadequate. Seriously, I wouldn’t let myself be treated by me. Maybe my feelings have something to do with the inherent disconnect between the basic sciences and clinical application/relevance. Even though we’re filling our heads with more information than imaginable, there really is no way to learn how to apply that information until we actually have clinical experiences and learn by doing and not so much by memorizing. I doubt that I’ll wake up one day sure that I belong in that white coat. Rather, as I gain more clinical experience and confidence over time, I will feel more at-ease in my white coat as I slowly, imperceptibly to me, instinctively begin to take on...
2. doctors are stressed outNo shit.  Being a doctor is stressful.  And it's especially stressful when you screw up.  But this is just ridiculous.  Some urologist in Romania got pissed that he screwed up an operation to fix a testicular malformation and chopped off the patient's penis and then diced it up like an onion?!  That's just ridiculous!  What was he thinking?!  No penis —> patient won't know that I screwed up his urethra?And then the audacity to blame his actions on stress from personal matters?!  We ALL have personal matters that stress us out.  But that doesn't make it okay to lop off penises!  Ever learn anger management?  Stress management?  Or for that matter, take the Hippocratic Oath?!  That's the thing about being doctors—we have to be invincible.  Our house could be burning down, our entire family murdered, and if we're dumb enough to still go to work and see patients, we have to be on.  Because being off could cost lives.  And that's what happened here.  Sure, this guy didn't die, but he's probably wishing he did.  If this doctor was so stressed out, why didn't he take a day off?  Better than harming a patient.Not only is this whole thing just messed up beyond words, but other doctors are complaining that his having to pay the damages to the patient sets a bad precedent?!  It's not that he made a mistake here that is common to such surgery.  He chopped off a man's penis!!!  I understand that making the doctor pay...
3. who needs a doctor anymore……when all I have to do is use Google? I’m just waiting for my mother-in-law and/or sister-in-law to tell me that and insinuate that it means even less to them now that I’m going to be a doctor since Google can do my job. I can just see my sister-in-law sticking her nose up in the air at me now. My job’s better than yours because Google can’t do it for me (oh, but it can—Google can do everything). It’s already bad enough that patients like my mother-in-law don’t trust doctors—do we have to really make it worse by making it widely known that sometimes, we need to use Google? Really, I’m fine with using Google to look up stuff, even medical stuff, which I was guilty of from time to time during my first two years of med school. But does everyone have to know? I know, I know—patients these days are more informed than ever before. And I’m fine with that. Really, I am. That is, if these patients have enough sense to realize that their internet searches cannot replace all the years of medical training that doctors have received as well as all their years of experience. And my mother-in-law is not one of those people. People like her will turn this study into leverage against doctors when they don’t tell them what they want to hear and every argument otherwise (like the fact that Google wasn’t very good at getting the diagnoses if the symptoms were...

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