Risk averse

One quality that is great in general internists is risk aversion. In my experience, general internists do not like to take chances. We play it safe. We measure twice and cut once. We are safe people.

In practice, that means we avoid risky behavior. We go with the established method. We recheck test results. We say things like, 'Don't trust the radiology reports. Look at the films yourself.' In reality, if the radiologist missed it, what chance do I have? We also preach from the rooftops about evidence based medicine. We know what we know. We are applied epistemologists.

But the problem with risk aversion is that I've taken it to another level in my personal life. I am totally gun shy. I like to gamble, but it's nickel slots. I like fine dining, but won't venture past five restaurants. I haven't asked a girl out in five years.

Regardless of the reward, I'm unwilling to take risks, and that is a quality that probably drew me to internal medicine in the first place. I'd be a terrible surgeon. But personally, my life is empty. Without risks, life is shallow and empty. I have no excitement, no joy. It is strange that a quality that helps so much with my professional life can be such a limitation in my personal life...


Sometimes, it's hard to say thank you. But I've got a lot to be thankful for. I've got a great job. I'm doing well financially. My life has achieved a good measure of stability. However, stable doesn't always equal good. One attending quipped to me as an intern, "All vitals stabilize and all bleeding stops... eventually." (For those of you not medically inclined, bleeding eventually stops when you've bled to death, and similarly, vital signs like pulse and blood pressure eventually stabilize at zero)

My life has reached a measure of boredom and stagnation that is difficult to stomach, even for myself. I've become completely still. I have nothing in my life to enjoy or anticipate. I am, in a word, bored.

And I think about what I want, and I just don't know. Should I be thankful that I'm not going through all the heartache I've lived through before, and that I've found a place of emotional stability, or should I be totally dissatisfied that there is no joy in my life?

The answer, as usual, is in between. I am thankful that I have a good job and a life that is calm and peaceful. And I am sad that I am so dissatisfied with it.

Positive teddy bear sign

If you don't believe me, do a Pub Med search. There is something called a teddy bear sign. It is positive when a patient is found to have a teddy bear at bedside or in bed with them. It usually indicates that the patient is regressing to childhood and also has a high likelihood of non-organic disease. Of course, this only applies to adults. I don't think anyone would fault a six year old for finding comfort in stuffed animals.

However, the teddy bear isn't the only signal that your patient is going to be trouble. Here are some signs that I know of, some of which I've read about, others are my own creation.

Parents Sign is when someone over the age of 40 is found to have their parents at bedside. Always bad news and along with the teddy bear sign often represents mental and emotional regression.

Scrubs sign is when a patient in the hospital is dressed in scrubs, a sure signal that they've spent so much time in the hospital that they start requesting clothing instead of the gowns.

Retrobulbar micturalgia is a screening question used for patients with a 'positive review of systems' syndrome. You ask, "Does it hurt behind your eyes when you pee?" and if the answer is yes, your diagnosis is confirmed.

Radiology sign is when a radiologists marks an x-ray so that even an idiot internist can interpret it.

The radiographic criteria for fibromyalgia are (1) at least 2 MRI scans of spine (count each spine segment, so a CTL scan counts as three), (2) carrying the MRI films and/or reports to initial visit, (3) need for Xanax or Ativan (by name) prior to MRI and CT scans, (4) symptoms in distribution contralateral to radiographic findings. Criteria are met if 2 of 4 findings are present.

Can you think of any others? Most of these are pretty cynical and jaded, but I have to admit are good for a chuckle.