All Supreme Court decisions aside I am loathed to use the above word. I hate it. I think it is vulgar and repulsive. Yet recently I find it popping into my mind with uncomfortable frequency. When does this happen? Let me give you an example.
Mikaela, the barely twenty year old mother whose baby I delivered in her final year of high school was in my office recently. Her live in boyfriend of the past two months came with her to the appointment. I am always a bit curious when a sexual partner comes with the patient to a gynecologic visit but over the years I have become increasingly comfortable talking with couples regardless of race, gender or their choice of sexual practices
Today the subject is a vaginal discharge. This particular patient has had a positive cervical culture for chlamydia twice since she has been under my care. The first time was at her initial prenatal exam in her pregnancy. She was then eighteen and she came to that visit alone. I asked her to bring her boyfriend with her to the next visit. Just as I had explained to Mikaela, I told that boyfriend chlamydia was a sexually transmitted disease. That it could cause a serious pelvic infection in her and blind their baby. It could even cause an infection in his reproductive system that could result in a great deal of pain and render him sterile. I instructed the two of them, just as I had instructed her when she was alone, that they were not to have sex again until they were sure that he too was free of this disease and that it was always best for him to use a condom to prevent the trasmission of this and other sexually transmitted diseases.
At this point the boyfriend seemed repentant, admitting that he had sexual relations with someone else and that he almost never used condoms. They were expensive. I gave him a hand full from a box that I keep in my samples closet. He also promised to go straight to the health department for treatment and screening for other sexually transmitted diseases, just as Mikaela had done in my office.
That was the first scenario with Mikaela. It was repeated six months after her baby was born when she had moved back home with her mother, who was now caring for the baby so she could work and go to school part-time. She and one of her college classmates began dating and she again contracted chlamydia. During her pregnancy and following it, I had several documented discussions with Mikaela about both contraception and prevention of sexually transmitted diseases.
As, I said, those occasions were two sexual partners ago and I recognized this man as someone new and I had introduced myself as I came into the room. Following the exam and genital cultures for bacteria, I again began to write out a prescription for the appropriate antibiotics, asking this new man if he was having any symptoms. When he answered, very politely I might add, "No ma'am!" I again explained the need for protection from sexually transmitted diseases as well as pregnancy.
Mikaela got an inquisitive look on her face as she said, "Now what did you say caused problem again?" Only the extreme patience I have developed over many years of practicing medicine and parenting kept me from replying, "F**king!"
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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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