September 30th, 2010

Don’t Take My Fun Away

John Mandrola is a cardiac electrophysiologist who blogs on matters medical and general at Dr John M. In a recent post, he celebrates his enduring sense that doctoring is still a great job.

“Did you sign those three consents?”

“This patient needs a short form; your office letter was 30 days and 1 hour ago.” (just over the legal limit)

“The insurance ‘people’ in area code (***) denied the stress test.”

“Mr Smith’s son, an alternative medicine specialist in California, wants a phone call to discuss herbal therapy of AF instead of ablation.”

To these and the infinite number of similar hassles, I have been responding with a new plea, “Please don’t take the fun out of doctoring.” Saying it out loud, like a childhood prayer, reminds me of the truth: that doctoring is, still, a really great job.

This week, two unusual things happened to me that reinforced this truth.

First, an internist called me to say there was a nearly 100-year-old who had heart block requiring a pacemaker. She is an enlightened doctor and knew my gut reaction, so she quickly added, “This patient is a good 95; we’ve already been there.” And then she said one more thing. “I have a fourth-year medical student who is rotating with me . . . can she come watch? I have no idea how a pacemaker is installed, maybe you could show her, and she could tell me.”

We are  only a scant few miles from the university, and yet a Berlin-wall–like barrier seems to exist between the private world and the university. Every once in while, though, a “younger” escapes on some elective rotation. They are sent out into the deep, dark forest of the private practice world. Such escapees are always young, and as time passes, they appear even younger.

To us nonacademics, there is nothing quite like having a motivated, youthful escapee to listen to your show-and-tell. The internist’s student had never seen an EP lab, a cephalic vein isolated, a simple peel-away sheath, or a pacemaker lead. Who knew that basic physics 101– the flow of electrons – would apply so directly to patient care?

“While she’s here, it wouldn’t hurt to show her some more stuff,” I thought.  Then there was a cardioversion.  So simple to us, so ‘shocking’ to the fourth-year medical student, who jumped a little with the patient.

“Ok, it’s time to go, I know you need to get back to your primary care rotation.” But on the way out, the young escapee peered into the interventional lab, as if to say, “what’s going on in there?” So we went in to see the “squishers.”  I am not sure what impressed her more – the visual miracle of a 90% blockage being reduced to nothing or the fact that the doctor was passionately chastising the ‘versed-ized’ patient on the dangers of persistent smoking while he squished.

“Dr Mandrola,” whispered a cath lab nurse, “I think I like having medical students around, too.” 

The second occurrence was late on a Friday, as I was rushing through the usual Friday-afternoon feast of documentation.  He was interviewing for a job, and I was to discuss our medical community. Just out of training at a major university in a major city, he was young, with small children and a wife who was a doctor as well. He asked about our medical community and whether I was happy.

I started to talk, and a surprising thing happened. Only the good things seemed to come to mind. Not that I was trying to bamboozle him, but the ‘cubicle-doctors,’ the forms, the pharmacy requests, and even the covert rationing of care were all involuntarily suppressed. The joy of doctoring came to the fore. Truths like: We have hard-working, good-hearted and well-educated colleagues (nurses and doctors) to work with, we have the support of a benevolent (albeit increasingly stressed) hospital administration, and, mostly, we have many grateful patients.

I stayed and talked later than I should have. Because it felt good to reflect on what is still right with the system. My academic colleagues interview incoming prospective faculty and students frequently, and as part of their charge, they get to show stuff to youngers every day. I’m envious of this, for sure. Such opportunities for reflection on what is so good about our profession are less common on the speedy private-practice treadmill. So when they occur they should be savored.  Writing them down helps me remember.


One Response to “Don’t Take My Fun Away”

  1. robin motz, M.D., Ph.D. says:

    The problem I have when I am ward attending is how few interns (let alone medical students) go down to the echo lab to review an echocardiogram with the attending, let alone actually accompany their patient and watch the process. They just read the results off the computer, and therefore have no idea of the limits of interpretation. I am really getting tired of explaining to 3rd year students that we ALL have trace mitral regurgitation on color Doppler. I did sharply speak to an intern: when I criticized his cardiac exam (I have all my housestaff as well as students examine a patient in front of me) because he only listened to the heart with the patient sitting up, and not supine (and heaven forbid I should mention left lateral decubitus) his response was “What’s the difference? I can always get an echocardiogram.” We are producing a bunch of technocrats who seem to think that lab values and xray reports come from the infinite universe directly to the ward computer.