Posted tagged ‘Medical education’

I’ll Just Say So Long

September 6, 2009

        Julius finished his rotation Friday.  My song of the day after he left was Tim O’Brien’s ‘Look Down That Lonesome Road.’  The tag line at the end is quite apropos.  It goes, ‘I hate to say good bye, so I’ll just say so long.’  Julius was the best med student we’ve had come through Harvey County in a long time.  I couldn’t say good bye, so I just said so long. 

        Besides, he’ll be back.  Believe it or not, Harvey County has gone plum modern.  We used to do all the I.C.U. work ourselves but now we have a couple of intensivists.  I knew Julius wanted to get into that kind of work, so I sent him over to see them to see if he could do a rotation with them late this fall.

        Our intensivists are two sharp guys we somehow lured here from the Mayo Clinic.  When they first showed up in town I realized my days as the local king of the bubble tests had come and gone.  (For those that don’t know the term, my son coined it.  In grade school when they had a standardized test I asked him if he was scared, and he said, “No sweat Daddy.  All you gotta do is fill in the right bubbles.”) 

        When I ran into this duo, I remembered my father’s counsel.  “Son, in this business, you’re gonna run into people smarter than you.  When you do, don’t be jealous;  go make friends with them.” I did just that.

        They are an odd duo with odd names.  Zellington and Grinzler.  Sounds like a World Wide Wrestling team, huh?  They are like an Abbott and Costello comedy routine except they got their punch lines out of ‘Harrison’s Text of Medicine.’  One, Zell,  is short and uh… stocky.  The other, Grinz, is tall and does his best to be austere in spite of Zell’s antics.

        When I sent Julius to ask them about doing a rotation with them he was concerned.  “I don’t know, Doc.  They’re from the Mayo Clinic.  Sounds pretty high powered to me.  Will they take me on?”

         “No problem, son.  When they ask you what your objective is for this rotation, just say, “I hear there is a lot of debate in Harvey County as to which one of you guys is smarter.  Dr. Bibey asked me to find out and report back to him.”

        Julius did as I said. Grinz took one look at him then said, “Smart ass,” and signed.  Zell grabbed the paper out of his hands and signed it above the line where Grinz did.   

         I also had Julius negotiate for Friday at lunch off so he could eat with me on the ‘Starving Medical Student Foundation.’  The boy did good.  We have an appointment at Chang’s Chinese the first Friday in November.  Like Tim O’Brien sang, “I hate to say good bye, so I’ll just say so long.”

       See you soon, Julius.

Dr. B

Here’s the link to Tim O’Brien’s tune:

www.youtube.com/watch?v=vMbNkyTCTG8

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Doc Rule Number Seven- Speak the Language

August 24, 2009

        Even before I finished med school, folks began to tell me I was a good diagnostician.  It would be wrong for me to take too much credit.  I learned the secret early on, and it was easy- listen to the patient.

        I was a good student but I realized when I got to medical school we had a couple who were brilliant, and I was not that gifted.  When we started to take care of patients I found my gift, though.  That gift was I liked the patients.  It was the secret to life as a Doc for me and I am forever grateful for it.

        I recall one fellow with malignant hypertension. (High blood pressure to a dangerous level)  I remember sitting by his bedside and saying, “Well we only have one more medicine to try, but it has a side effect you might not like.”

        “What’s that, Doc?”

         “It can make you hairy.”

        “Well, I hope it grows in the right places.”  (This was a burly man who had hair everywhere except on his head)  He got a big laugh.  I always had a way with people.  By the way, the medicine was Minoxidil, which later was reformulated as a lotion and marketed as Rogaine.

        In med school, we used to make rounds with an entourage; attendings, residents, students, etc.  Some of the students tried to make every diagnosis from a text book.  I read the books too, but I’d often make my diagnosis after the entourage left.  Sometimes the attending would talk ‘at’ the patient.  You could see the patient all but beg to get in a word.  After the team left, I’d go back in the room and sit down with the patient and the family.  If it was a slow night sometimes I’d watch part of a movie and eat some popcorn with them.  There they’d tell me everything that was on their mind.  I never had any trouble figuring out what was wrong.

        It bothered one fellow student.  “How’d you get so smart all of a sudden?” they asked.

        “I dunno.”  I tried to explain  a couple times.  I never could understand how such a smart person couldn’t get such a simple concept.

         By the end of med school I was pleased about my progress.  They had an award for most promising Family Doctor.  As has often happened to me in life I was the runner-up.  The kid who won stayed with it a year and then changed to Radiology.  Oh well.  I’ve been happy enough with my lot in life even if I didn’t win the award or get rich and famous either.  My patients tell me I am a good Doc for them, and that is the only award that matters to me.

        This is an old med school story.  Like many it might be only a legend, but it is still a good one.

       Seems there was an old preacher who had prostate cancer.

      The attending made rounds and said, “Reverend,  tomorrow we will proceed with an orchiectomy.”

        “Whatever you say, sir.  You Doctors at Sandhills are the best in the country.  I trust whatever you say.”

        The resident was skeptical.  After the attending left he said, “Pastor, we have you on the OR schedule tomorrow to have your testicles removed.”

        “Whatever you say, sir.  You Doctors at Sandhills are the best in the country.  I trust whatever you say.”

        The med student watched all that and was not at all certain the man got it.  He decided he’d better explain one more time.  The boy was from the country, and he wasn’t all that sophisticated, but he thought he knew how to communicate with this man.

      “Preacher, I just want you to be sure you understand, but in the morning they’re gonna cut your balls off.”

        The hell they are!!

       The point of the story:  It is imperative to speak the patient’s language.

        And by the way, that is as close to off color as you’re gonna get from Doc, but I thought it made the point.

Dr. B

Man Cave Hyperlipedemia- Country Doc Rule Number Five

August 14, 2009

        Just to let you know, Doc can learn from the student too.  Julius has gotten in the habit of giving folks a package insert on new start drugs.  He goes over the basics then asks them to read up it and get back with us if they have questions.  It covers a lot of ground in a hurry.

        His recent contribution was the spark for this post.  Today I’d like to post a Julius rule.  I’ll tell more of mine later.  Rule number five is to make learning fun.  I have always believed that, but Julius is young and has taken the concept to a new level.

       The other day we were at lunch and Julius said, “You know Doc, I wish I had my dart board here for lunch.”

        “Dart Board?”

        “Yeah.  At home I have one in the apartment.  Some of my buddies come over at night and we toss darts after we cook on the grill.”

       “Is that like one of those man caves they talk about?”

       “Yeah, exactly.  Could we have one here?”

        “Darts at lunch?  I don’t know man.”

        “Hold on a minute.”  He went out to the car.  In a minute he was back.   “Look here.  This is how I memorized the hyperlipemia guidelines.  I call it the Simvistatin Dart Board.”  The bull’s eye had the number 70.  “See, if your patient is diabetic you want to hit the 70.  (An LDL of 70 is the goal for a diabetic.)

        “Son, that is the coolest teaching aid I have seen in some time.”

        Before you know it we had the hyperlipidema dart board up and running.  At lunch Julius and I invent clinical scenarios, decide on the correct LDL goal indicated, and take turns at darts.

        I held a dart and poised to throw.  “O.K. Julius, my patient is a 67 diabetic, and status post coronary artery by-pass.  What’s my target?”

         “Trick question, Boss.  By the time the next guidelines come out 70 ain’t gonna cut the gig.  Like blood pressure and golf, go low.”

         “You are a good kid.”  I winged my dart past the coffee maker.  “Bull’s eye!”

        Julius laughed.  “Never bet against old Docs at golf, darts, or bubble tests.”

        Our lunch break is usually 20- 30 minutes and we’ve taken to darts for half of it.  We went all out.  We’ll order a bacon swiss cheese burger basket take-out from Lou at Harvey Billiard and Bowl.  We put some of those frosty beer mugs in the refrigerator to pour up our Co-Colas in.  We even got a dish of dish of cocktail peanuts and took to betting nickels.  We left off the swinging doors though.  I think Corporate has a rule against alteration of the physical structure.  After a week we’d memorized every algorithm known to the Heart Association, and had gotten dang good at dart tossing too.  Hm.  Makes me wonder if we’ve got room for a pool table.

         Last night when I got home Marfar asked how my day was.

         “It was great hon.  Me and Julius are having all kinda fun.”

          “So, what did you do?

          “Oh, today we went to a bar and threw darts.”

         She gave me a sideways look and smiled.  “Whatever winds your clock, dear.”  She knew there was no point in asking.

Dr. B