Monday, October 03, 2005

Resident Rounds

Rounded with the residents this weekend, which was tiring for me and no doubt horribly grueling for them. Not that I have sympathy, because hell, I went through that and worse. I do, however, have recognition.

Hospital rounds confirm time and time again a simple fact of life: illness of any type sucks. Illnesses are usually painful, they disfigure, they impair function, they limit life. They affect the young, but mostly the old.

But it's an odd thing that the more the illnesses disfigure, hurt, limit - the easier it is for the doctors. There's an almost disgusting ease about caring for the very ill patient which makes you think, for example, OK, big heart attack - put on big heart attack pathway. And you don't have to think about it anymore.

It's when illness is on the fence between horrible and benign that you have to give a patient thought and experience and reading. So that chest pain isn't from the heart, well then, where is it coming from?

That's tough.

Anyway, now I have to get back to it. Short one today.

7 Comments:

Blogger acumamakiki said...

What an interesting perspective, but it makes sense. The worse they are, the easier it is to go into that mode and work from there.

Vague anything is hard to work with. I imagine in convential medicine it's very hard because it often means life or death.

With acupuncture, the vagueness just means that the patient will probably stop coming if I can't figure it out.

7:06 AM  
Blogger Doc NOS said...

I tend to think of acupuncture as symptomatic treatment. Pain here, stick there. I don't need to know what tissue is responsible for a certain pain, but I do know that morphine will treat it.

Usually the life and death questions are obvious. What is less obvious are degrees of eventual disability.

Anyway, I was struck over the weekend that when things are obvious, it's bad for the patient, easier for us.

10:05 AM  
Blogger acumamakiki said...

Acupuncture can actually do more than symptomatic treatment actually. Although certainly that's when most people seek my services.
Yeah, I see your point about the obvious and also, life and death issues.
I can't imagine having to be the one to tell a patient about the eventuality of their illness.

10:29 AM  
Blogger laurenbove said...

my doc told me: you probably have ra. you have no symptoms. come back when you do.

3:19 PM  
Blogger marybishop said...

After watching House on Fox, I'm beginning to think that all doctors face painful decisions they have to make based on their best educated guess as to what is wrong with a patient.

When it's obvious what is wrong, it must take away that fear and worry that perhaps it isn't A but maybe B that is wrong.

Do you ever watch House Doc?

8:54 AM  
Blogger Doc NOS said...

LB: that's the danger of ordering tests with few symptoms. It sounds like you've fallen into the not obvious catigory, which is, of course, better for you. RA sucks.

I have seen a single episode of house. Not only was the acting terrible, the dialogue stiff as a cirrotic liver, and the plot driven by the stupidest medical McGuffin ever dreamed up (they gave the kid SSPE in the end, which is, despite their attempts to change facts, untreatable and fatal - thus making the entire preceeding hour one big waste of time), but the premise of the show seems to rest on the gimpy shoulders of the Big Grump. It makes me happy I don't have cable.

10:06 AM  
Blogger drogidy said...

Yeah, it's a sad state for Hugh Laurrie who had such a distinguished career in Black Adder. Well, I guess he has to work.

It is contrived television, and must seem painfully so to a real medic, but Hugh is still likeable in any role.

10:26 PM  

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