I have often wondered what families who do not contain a "medical person" do for medical care. I am not referring to diagnosis and treatment. Please don't misunderstand. Everyone in my family has a physician. I am talking about the persistence and the proper vocabulary to make the person who answers the phone at the doctor's office understand the importance of the problem and the fact that you expect attention before the end of the decade.
I am reminded of the time my father had a 103 degree fever on a Sunday afternoon. Elderly and with multiple medical problems, I am sure this was a situation, the severity of which even the newest answering service attendant would understand and page the physician. Yet, due to the slow response my father had received on previous occasions, he refused to believe he could even talk with the doctor on a Sunday afternoon.
In fact, my father did not call even me. One of my cousins happened to drop by my parents home and called me to apprise me of the situation. When my father told me, "Well you can't just call a doctor on Sunday afternoon!" I ask him how many times he had been present when my beeper when off on Sunday afternoon, at night, during dinner, or a dozen other times that might be inconvenient. "That's different," he said. "You deliver babies."
True. I do deliver babies but when I was in private practice I got calls about everything. Patients use to call me about their husband's chest pain and their mother's fractured hip. Most of the time I tried to answer those questions just like I do with my our family members, "Have you talked to the doctor taking care of this problem?"
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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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