Early in my medical career, I was privileged to practice with a wonderful, witty physician who was well known and respected by physicians and patients alike. Much of my philosophy of medicine developed as we worked together.
The son of a prominent gynecologist and the grandson of a prominent Methodist minister, I am sure that Dr. S had his choice of careers. His college major was philosophy. Enjoying both people and science he followed his father's foot steps into medicine. After four years of medical school, a year of research and four years of residency he joined his father's group of obstetrician-gynecologists in private practice. The following is a story that he once told me about a new patient he saw in his first week in the office.
It often falls to the newest doctor in a practice to see the newest patients. Sometimes these patients are the ones with the worst problems. At other times they are simply the patients that will take more time. This was the case one day when the young Dr. S was given the chart of a 15 year old girl brought to the office by her mother for prolonged and heavy vaginal bleeding. The girl's mother was a patient of Dr. S's father.
Dr. S carefully went through the new patient history recording every detail. The young woman was shy but his calm, jovial manner soon had her smiling as the two of them engaged in a conversation about her medical history with her mother present. The young woman stated that she had never had sexual intercourse nor used tampons and at the mention of an examination she seemed very hesitant. Dr. S explained in detail how he would do a pelvic examination to determine the cause of her heavy and prolonged bleeding.
Concluding his explanation, Dr. S ask the young patient if she had any questions. Amazed at the idea of a pelvic examination, which obviously her mother had not explained to her before their arrival, the young woman's face became quizzical. "I just have one question." She leaned over almost as if to whisper so her mother would not hear. "Does your mother know what you do for a living?"
Dr. S, with I am sure a gleam in his eye, leaned a bit closer to her as he whispered back, "I think she must," came his quick reply. "You see my father does the same thing."
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
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