Today I am considering a change in the title of this blog. Loco MD seems more fitting. Recently I left the security of a well respected group to practice as an obstetrical hospitalist. Every day I have at least one second thought. This morning it came as I was delivering a 17 year old patient. The "baby daddy" was there very curious about all that was taking place. I was equally curious about how he was keeping his pants from falling down. The pants were riding about 4 inches below his waist to allow more than adequate exposer of his underwear.
Two days ago my second thought occurred as I dealt with a patient laboring after she had taken PCP. I had forgotten about the vertical nistagmus. The patients eyes oscillate up and down very rapidly. I know of no other instance when this happens. Patients on PCP can also be quite agitated which is understandable if your eyes are jerking up and down about a hundred times per minute. Have you have seen that commercial with the fried egg - "your brain on drugs"? Believe it!
I also spend way too much time thinking about who is taking care of those toddlers left at home. One of my standard questions after I find out the ages of previously delivered children is "who is taking care of them." "My mom" is a common response. In a short time I have concluded there is a large group of children being raised by their grandmothers. I am hoping the grandmothers do a better job the second time around.
I have also become way too familiar with filling out and signing death certificates. These dead certificates are for babies who died before their mothers came to the hospital. Many times the delivery of their dead baby is all the care these women get for their pregnancy. Drugs are frequently involved.
I came to this job through a series of events that have happened over the past two years. I could be seeing patients in a high profile wellness clinic in the wealthiest part of the city. That job was my second choice. At the time I believed it was too tame. I still do.
I write these things to say that I was not as well prepare for this job as I thought. Still it is what I wanted. And still it is work worth doing.
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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?
4 comments:
wow.
Thank you for writing and for the work you do.
In response to the comment about the grandmothers - I know they're trying. I have taught so many students who are being raised by grandparents - and I think they just don't know how to get out of the cycle of what they've done before.
Yes, I believe you are correct. The grandparents do not know how to break the cycle. I often think of Hull House in Chicago in the late 19th century, where progressive women helped immigrants learn better care for their children. I see some of this at the free clinics in the area. There are many resources if we could just get people to access them.
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