Musings
Back in the Saddle
27 October 2008
After five and a half weeks, I finally
got back on my bicycle. I had left my sling behind the week before
and my shoulder was feeling pretty good. The weather was Indian
summer perfect with bright sun and temperatures in the low 70s. So
I went. It felt good to be back on the bike. The drive chain
hummed, the pavement sushed by, the gears clicked, and I reveled in
the pleasure of exertion. As I passed the spot where I had crashed,
I spit on the pavement as a gesture of defiance. A little childish
maybe, but if we don’t defy our ghosts, maybe they chase us back
inside to the recliner, or to the grave.
Quantity vs. Quality
18 August 2008
Which is the greater good: to serve
more people or to serve fewer ones better? To be more specific, in
my current medical practice, I see a far greater number of patients
than I did previously. Consequently, in a given day, I spend less
time with each patient. I now can pretty much classify any new
patient and their symptoms into one of a relatively small number of
categories within the few couple of minutes of the encounter.
Rapidly I can begin to triage their workup and select what
diagnostic or therapeutic options I will employ. There is a limited
number of clarifying questions I will ask. I try to do a little
patient education regarding new drugs or unfamiliar diagnostic
tests. If the patient has any questions I try to answer them. Then
I speak some “transitioning” language so as to prepare the patient
to be checked out by my staff. And I move on . . .
Many of our patients are poor or indigent. Many don’t have a lot of formal education. There’s a high incidence of smoking, obesity, diabetes, and sedentary lifestyles. It’s difficult to explain complex concepts of cardiac anatomy and disease pathophysiology to them. Usually if I try to engage them in the decision making process they just shrug and say “whatever you think, doc”. The most worrisome disorder - coronary artery disease - is highly prevalent and dangerous when undiagnosed. Yet the symptoms are often misleading or non-specific. The physical exam is nearly useless. But with a ten second CT scan that I might order, I can instantly see a “snapshot” of their cardiac risk that creates immediate direction for their therapy-or major reassurance when negative.
So what’s better? Should I spend more time establishing a relationship with these patients (most of whom, if new patients to the practice,are referred anyway by the primary providers for a consultation) or should I attempt to see a larger number so as to provide more of them with useful even potentially life-saving information and advice? I wonder . . .
Many of our patients are poor or indigent. Many don’t have a lot of formal education. There’s a high incidence of smoking, obesity, diabetes, and sedentary lifestyles. It’s difficult to explain complex concepts of cardiac anatomy and disease pathophysiology to them. Usually if I try to engage them in the decision making process they just shrug and say “whatever you think, doc”. The most worrisome disorder - coronary artery disease - is highly prevalent and dangerous when undiagnosed. Yet the symptoms are often misleading or non-specific. The physical exam is nearly useless. But with a ten second CT scan that I might order, I can instantly see a “snapshot” of their cardiac risk that creates immediate direction for their therapy-or major reassurance when negative.
So what’s better? Should I spend more time establishing a relationship with these patients (most of whom, if new patients to the practice,are referred anyway by the primary providers for a consultation) or should I attempt to see a larger number so as to provide more of them with useful even potentially life-saving information and advice? I wonder . . .