In addition to having a special vocabulary, medicine has its own set of acronyms. PERRLA stands for "pupils equal round reactive to light and accommodation." All medical students learn this when doing the first year course in physical diagnosis. Medical students also learn the importance of preforming both the reaction to light AND to accommodation. The reaction to light is when the doctor pulls that little penlight out of her pocket, darkens the room and points the light directly in first one eye and then the other. In the darkness, your pupils should get bigger. The bright light will make them smaller. Accommodation is where you are ask to focus on an object, say the physician's finger held out in front of your face, and watch it as he moves it closer to your nose. With this your pupils should also grow smaller.
As every medical students learns, neurosyphilis reduces the pupils ability to accommodate. Back when medical school classes were made up of mostly male medical students taught by male professors, the way to remember this bit of information came in a story about prostitutes who have neurosyphilis and will "accommodate but they will not respond."
As an intern long ago, I carried a spiral notebook in my pocket with just such a list of acronyms. This was in a time when husbands were confined to the waiting room while their wives were in labor unless they had gone to childbirth classes. This was carried out with such seriousness that certificates were given to the couple and the labor nurse was required to put this certificate on the patient's chart before the father was allowed in the delivery room.
I remember my first solo delivery. As the nurse anesthetist and I pushed the patient's bed to the delivery room, she kept asking me, "Is this an FID?" I had no idea what an FID was and I panicked. Did this woman have a condition which had escaped my attention? Could it affect her health or safe delivery of this baby? Looking in my notebook, I could not find FID. Finally, as we were moving her over on to the delivery table and I realized I would not have time to look through her chart again before the birth of the baby, I whispered to the nurse, "What is an FID?" "FATHER IN DELIVERY!" she shouted back. "No," the nurse replied. "He didn't go to childbirth classes, so he can't come in."
Well, now we have FOBs. FOBs are related to FIDs. Now, instead of pushing the patient down the hall to a delivery room, we have labor, delivery, and recovery rooms or LDRs so everyone gets to come in, at least for the labor and some patients choose to have several people present for the actual delivery. One obstetrician pointed out there was only one thing missing from the LDRs - the bleachers.
But back to FOBs. This is the term which is now quite common for the father of the baby. It is usually used when the patient and the FOB are not married. In private practice thirty five percent of my patients were not married at the time of their first OB visit, however, many did marry before the baby was born. In my current job, many not only don't marry but the FOB is the father of several other babies born to other girls.
In my continuing search for why this state has the highest teen repeat pregnancy rate, I believe accountability of these FOBs is an essential step to reducing our teen pregnancy rate. Accountability? Yes, the FOB's name on the birth certificate. Then they would be required to do more than swagger around the hospital room and brag to all their friends in the hallway. With the FOB's name on the birth certificate, the FOB could be made to pay child support. And if the FOBs are out working and paying child support they would have less time available for repeat preformances.
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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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