Medicine is a dicipline of uncertainty. So clinicians are always looking for indicators of certainty. We’re looking for signs. Medical signs. The psoas sign indicates an inflamed retrocecal appendix. A sentinel node is a classic sign of dissemination of cancer into the chest. The Cheeto finger sign (telltale orange fingers reflecting the recent consumption ... Continue Reading about Medical Signs
Interrupting Patients for the Right Reasons
Not long ago I entered an exam room and was met by a mother who immediately began talking. From the chaotic feeding to her sequence of formula roulette and the staccato of the baby’s cry, she delivered a near full history of present illness in the span of 45 seconds. And all with one breath. While I was impressed with her delivery, I couldn’t keep up. So I ... Continue Reading about Interrupting Patients for the Right Reasons
Medical Tests – The More You Order, the More You Explain
I spoke with a young pediatrician recently who complained about her late hours in the office. A lot of calling patients with questions about labs. On cursory review, she seems to do a lot of medical tests. It makes sense. Here’s the math: Two sessions per day of 10-12 children per session and everyone gets a comprehensive metabolic panel (as an example). 48 hours ... Continue Reading about Medical Tests – The More You Order, the More You Explain
Medicine is a Profession of Response
Medicine is a profession of response. Physicians exist to respond to things. All day long my clinical work is sequence of responses to all kinds of things. Symptoms, signs, concerns, reactions, questions, findings on diagnostic studies. When my Epic inbox is empty I go home. There’s nothing to do. If things stop happening to children that need my input I’ll be out ... Continue Reading about Medicine is a Profession of Response
Doctors, Joy and Background Work
If you don't like the most basic problems faced by a specialty, you risk being miserable as a physician. Those who can't handle the background work end up in administration or taking an exit for something else. More important than the ability to embrace a specialty’s most basic problems is the ability to find joy in the process. For me, joy comes from engagement ... Continue Reading about Doctors, Joy and Background Work
The Danger of What Doctors Were Trained to Do
I hear this a lot from young and mid-career physicians in the face of new information, “But I was trained to...” 'I was trained’ suggests knowledge and standards are static. The way things were done is the way things are done. It fuels the myth that our mentors could do no wrong and they knew everything. 'I was trained’ is a dangerous way to think. It closes us ... Continue Reading about The Danger of What Doctors Were Trained to Do