The local MD: What's in a pill?

Monday, January 19, 2009

What's in a pill?

Today was a holiday of sorts and I made it home in time to watch the evening news learning something that will help me in the future.

In for her annual exam, I was reviewing the list of medications with a patient this afternoon. "Well, I am on something for my cholesterol but I just can't remember the name," Mrs. S said with a puzzled look. "At first I was taking that one with the guy rowing on the lake. You know him, he invented the artificial heart."

Yes, I had seen the commercials for her old medication but tonight I figured out what medication she is currently on. "But I am not on that one anymore," she had continued. "It caused some problems so now I take the one with the young African American woman in the commercial." Got it. I saw the commercial. Now I can record the correct medication in her chart.

In medical school and residency I frequently learned to recognize a medication and the dosage based on the color of the tablet or capsule. Generics changed all that as it is impossible to keep up with appearance of even oral contraceptive packaging. Now with direct to consumer advertising the television commercial is often a point of reference for the patient.

I just wonder if a change we can believe in is a lowering of medication cost by removing some of this direct to consumer advertising. Then perhaps patients will begin to believe that a pill recommended by anyone other than Sally Fields might be effective to treat their osteoporosis.

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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?

The local MD

Monday, January 19, 2009

What's in a pill?

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Monday, January 19, 2009

What's in a pill?

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The Local MD