Sunday, October 12, 2008

By The Way, I'm Also Great at Removing Wax from Ears

Years ago, before I started medical school, I thought it was so simple. I would become a doctor. The answers would role off my tongue. People would come to me and I would fix them. I would rush into the hospital room and singlehandedly save the day. It was so obvious. It was so straightforward. It was so laughable.

Back in those days I didn't undersatnd the complexity of medicine. I didn't understand that often the answers are not so clear. That sometimes there are multiple possibilities and it is difficult to differentiate which is right. That sometimes no matter how hard you try.... you miss the mark. That diseases are more likely to present atypically then in textbook fashion.

My naivete was shattered throughout residency and my first few years of practice. I would continually search for the textbook answers and they would often miss lead me. A clear case of cardiac chest pain would end up being heartburn.....and a clear case of constipation and indigestion would end up being a heart attack. The gods of medicine were laughing at me and I was fodder for their cruel sense of humor.

But as time has passed I have started to understand the patterns of human beings better. I am now more likely to diagnose appendicitis by the look on a person's face and their demeanor then anything I specifically note on physical exam. I am now apt to understand that testicular pain in a young man is just as likely anxiety and depression as it is orchitis or a hernia. I have learned these things. Not by reading them somewhere in a textbook but by missing something vowing never to forget.

The medicine I practice today is much more nuanced. I watch the way patients walk into my office. I pick more up in their facial the words that aren't said. I understand a little better how people work. How they describe their own pain. What the diffetence is between psychic and physical pain. And how to try to treat each.

I also have learned that as a primary care physician I rarely race into the hospital (or office) to save the day. I will leave that for the surgeons. What I do is a lot more tame, a lot more calculated. Although I have never found myself to be a religious man I still beleive that we as humans have only so much power over our own lives. Sometimes people will either live or die and I as a physician may have very little to do with it.

I see my role as more behind the scenes. In those who are living I try to foster life with less pain and suffering. Less worry and concern. I manage their back pain, and diabetes , and heart disease. Like an insurance policy I am a crutch to help face the unimaginable...the unthinkable.

In those who are dying I try to fashion a softer landing. Ease the pain and desperation of what they are going through. I try to get them home and with their families. To die pain free surrounded by those who love them. Sometimes it works, sometimes it doesn't. But there is beauty and salvation in the attempt.

So I guess you could say as a primary care physician I am a jack of all trades. I help people live. I help people die. I try to manage ilness behind the scenes so people can live their lives. And occasionally...occasionally I rush into to save the day (if I'm lucky).

Oh...and by the way

I'm also great at removing wax from ears

1 comment:

tracy said...

i just "discovered" your blog and i love it. What a wonderful entry. i admire all physicans, but Primary Care physicans in particular. You have sooo much to deal with and it seem you get so little reward at the end...i am sorry about that. i have a fantastic Internest, i am sooo fortunate....i am always afraid he will decide to go in to another area of pratice, because of all the hassels PCP's go through.
bless all of you,