Pencils and crayons, part 2

The word "acumen" means a quickness of perception and discernment. In medicine, someone with clinical acumen is sharp and fast to an accurate diagnosis with minimal effort or information. A doctor will walk into the room, take a quick smell and a glance, and pronounce to the patient, "You have a bleeding peptic ulcer." The patient and all the house staff are astonished at the quickness and the veracity of the diagnosis, and sure enough, the endoscopy proves him right.

The reality is that the doctor could smell the distinct odor of melena, and observed upon walking into the room that the patient was eating a plate of hot wings his wife had brought in, and had a beer belly. It was a pretty safe bet that he had an ulcer.

Acumen comes from the Latin word for a sharp point. And so, just like sharpening a pencil, clinical acumen needs to be sharpened too, but it's hard to keep sharp, easy to dull, and sharpening itself takes work. Because the way most of us physicians keep our acumen sharp is honed on the bodies of the dead and dying left in our wake.

I won't miss pancreatic cancer again because Mrs R is dead now, and maybe I could've done something to stop it if I'd only found it sooner. I won't use steroids to treat acute arthritis if I haven't ruled out a septic joint, because I've seen what happens to an infected joint that gets steroids.

Keeping a pencil sharp takes some effort, not much but some. Keeping a crayon sharp is an exercise in futility. At the end of the day, it's not just the sharpening that takes work, but we have to strive to be something worth keeping sharp.

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