Stethoscopes

Digital things are nice sometimes, but there are times when it's overkill. One such place is physical diagnostics. Nowadays everything is digital. It's next to impossible to find a manual BP cuff, to the point where I'm thinking of carrying one in my coat. And the new rage is the digital stethoscope.

This stuff is ludicrous. And I say so as someone who owns 3 digital cameras and buys DVDs and CDs with some sort of unholy compulsion. Obviously, technology offers benefits, otherwise I'd be wasting my money. But it's not without its follies.

With cameras, everyone loves digital for the convenience, but truth be told, I'd rather shoot film. Film is an art. It takes skill and care and a thorough understanding of the medium. It captures a range of colors and shades that is unmatched by digital. Even the crappiest film picture rivals the best digital can offer.

Don't get me wrong, I've gone through 2 rolls of film in the last year, and I own 3 digital cameras. I've obviously been sold on digital, but it's no substitute for film. It'd be like trying to replace a Steinway grand piano with a Casio.

But when it comes to medical diagnostics, there is no replacement for analog. We've sold into this digital world, with automated BP cuffs and pulse monitors, but if you've ever worked with me, you should know that I trust these things like I trust a rabid coyote in a butcher shop.

You simply cannot replace the art of BP measurement with a machine. And similarly, I wouldn't trust a digital stethoscope, because it is simply taking sound, making it digital just to make it analog again.

Part of the wonder of medicine is interacting with people, and it makes me a little sad to think that we're coming up with more and more ways to distance ourselves.

Please understand me

The Kiersey Temperament sorter is one of those things that I do every year or two to see where I'm at. When I was in high school, I was a very strong ISTJ, which is very detail-oriented, probably the nerdiest of the personality types. Somewhere in college, I became an ISFJ, which was much more consistent with a career in medicine. The type is called the Protector and is common among general medicine practice.

Once I got into medical school, I had a subtle shift from ISFJ to INFJ, and right now, that sounds about right. I was trying to figure out my career choices in medicine and when I looked at the INFJ careers, it was my residency dilemma in grid form.

But reading through some of the stuff on INFJ's, I realize that other stuff hits home too more than just choice of career. I don't really believe that something as banal as a questionnaire has the power to explain my life, but it's a useful tool for introspection.

Some things really made sense, like my utter inability to take praise, or my ability to work well with people despite being horribly introverted. Or how I hate taking leadership positions, but when I do, I run a tight ship. But much like that crappy TV show "Crossing Over" it's easy to say these things and get people to identify.

The relationship stuff was pretty much right on. I have no interest in relationships that won't go anywhere, and I really do prize intimacy. What's the point of dating if it never goes anywhere? I'll admit that I've had opportunities, but it's a waste of time going out with someone if she's not someone you'd want to spend time with. There's sex I guess, but I'm a good little Catholic boy.

And besides, I'm not interested in sex as much as I am intimacy. I'd like to be close to someone. I feel like there's no one in my life who has ever known me intimately, and that's sad. And on bad days, I wonder if it'll ever happen. But like I've said, my outlook on life isn't as gloomy as it used to be, but it's hard not to feel alone sometimes, and that's not something you can overcome by yourself, y'know?

You can't go back

I met a 1st year medical student and it was very strange meeting someone who's so far back in the process I started what seems like a lifetime ago. I can barely remember being a 1st year, but what I do remember is with some fondness. I miss it.

Well, to be fair, I don't miss the stuff that happened as much as I miss the stuff that I thought would happen, if that makes any sense. I thought that med school would fix all the problems in my life, much like I thought high school and college would.

I thought that my life would enter a new phase and that things would be different, and I even tried to be different. I acted all extroverted and put myself out there, and expected some reward for my troubles. I got rewarded all right. My friends I'm sure recall with some chagrin that emotionally I did pretty badly in my 4 years of med school. And part of that was setting myself up for failure. My expectations were too high.

If you asked me the day before first year where I thought I'd be right now in my life, I honestly thought I'd be married by now. Really. Part of me still has a hard time believing that I'm so very far away from anything resembling marriage. I thought that I would find meaning and fulfillment, but that too seems rather intangible.

Maybe I'm too idealistic in this whole matter of my life. I have a lot of rules, as my friends enjoy to point out. Maybe too many rules. And I have to wonder if maybe not having so many rules would move things forward instead of stagnating.

Names

I think that I can manage to get more done in the hospital than most, and I'd like to say that it's my razor sharp clinical acumen, but in reality, it has next to nothing to do with my clinical skill. Because honestly, I'm not that good. My medical students were shocked to discover that their all-knowing senior resident only scored a 200 on his Step 1. One even asked me, "Two hundred and..." "No, exactly two hundred. Two zero zero."

I am, as one might say, not that smart. It goes without saying that I'm in the top 10% in this country, seeing as I've graduated college, obtained an advanced graduate degree, and am now training in a profession, and my IQ's prolly in the 130-140 range. But does this mean that I'm a smart doctor? Not really. I haven't made too many mistakes, and I have yet to kill anyone that wasn't already on the way out the door. But I'd have to say, there are better doctors out there.

But still I've managed to outperform a lot of these geniuses in the hospital setting and the simple reason is because I've bothered to learn people's names. I wish I was kidding. That's it. All it takes to be an outstanding doctor. That's my great secret.

It sounds so silly, but people actually feel a lot better when you address them in person, as an equal. When I was an intern, I'd track down the nurses for my patients, make sure they were squared away, find out what needed to be done from their end. I'd befriend the clerks and techs and respiratory therapists and it became easier and easier for me to do more and more difficult things, because I knew who to talk to in order to get stuff done.

And that's my great secret to being a good intern. Oh yes, and not killing people. That's important too.

So you wanna be a doctor

When I was an intern, I had a patient who, after extensive workup, had a simple fecal impaction. He was in need of manual disimpaction, which has to rank up there as one of the most humiliating jobs imaginable.

The matter of actually disimpacting someone isn't so bad. It's relatively simple. It's figuring out who's going to do it. And to be fair, I could've told the nurse to do it. Surgery was on board: I could've had the surgery residents do it. But I had some time in the afternoon, so I did it. I didn't get much, but a little rectal stimulation and some judicious enema use, and voila, one working colon.

And everyone around me asked me the same question: why did I do it, when I could've just dumped the work on someone else? It would've been quite easy for me to call surgery and say, "This is your domain. Do your worst." Or I could've told the nurse to do it. Wouldn't have made any friends, but wouldn't have had to do something that I'd rather forget. And honestly, I couldn't believe the attitude.

Y'know, I'm a doctor, and I'm taking care of patients, and they're my patients. They're my responsibility, and at some point in time, someone has to say that the line stops here, period. It's like heparin dosing. I track the PTT's, because while it's someone else's job to monitor that stuff, it's my name on the chart. It's my care.

Whenever I meet pre-meds, I try my best to discourage them, not because I am cynical or spiteful. It's because people go into medicine and don't have a clue what that means. They think it means sipping scotch neat at the country club and talking about how to improve your short game, or picking out which BMW to buy. Even worse, people go into medicine thinking that it's all about saving people or comforting the dying.

If you want to save people or comfort the dying, be a priest. Seriously. It's a better use of your time. Medicine is about dealing with shit. It's pulling stool from a grown man's rectum, or losing sleep at night trying to remember if you ordered a CT scan, or arguing with an HMO about getting a patient's MRI covered. It's messy work, and no amount of BMW's or scotch or people in the community kissing my ass is ever going to make it worthwhile.

The reason to go into medicine is because you love it. It's because seeing sick people and helping them deal with their illness is something that you enjoy doing. You can sit in a radiology suite, sip coffee all day in scrubs, earn $250k a year, and still hate your life. MD after your name won't fix that.

I knew I was in the right line of work when I had a patient of mine in the hospital, and I can't stand this patient in the clinic. One of my chronic pain med patients. But the patient needed surgery, so I stopped by, and we chatted for a while, and I realized that as much as I don't like taking care of this patient, it's my responsibility. If not me, then who?

When you are faced with the most unappealing jobs in life, like trying to manually disimpact someone, and can still go home and add up the day and come up in the black, you know you're there, because any number of people I know in medicine would've endlessly complained about such humiliating work, and I would not let one of those people take care of me.