Tuesday, March 14, 2006

The Curbside

Perhaps it's a measure of nothing. Or how falsely confident some doctors get when discussing cases with peers. Or perhaps it's a measure of clear thinking and excellence. Either way, I've been getting a lot of curbsides lately from people within my specialty.

Doctors do this more often than you think. I'm sure that most patients believe that their doctors have pretty much 100% certainty as to what's going on, what to do, and how to treat it. But even with classic presentations, there's a lot of wiggle room.

The latest was a slightly atypical presentation of a typical disease. This also happens more often than you think. Nothing in medicine is ever 100%, and the more tests we devise for things, the more data we get, the more likely for these various ducks to be slightly off line. In this case, although the presentation was stroke, the imaging looked like infection (although this was only described to me), in the absence of anything else going for infection: fever and blood work and the like. Just that one little duck, pointing away from mother. Reassurance was in order. No need to invoke something odd here. No need to work up infection. But that's just what he did - worked up a primary infection, which meant another duck portion of data, this one pointing away from infection. Sometimes you just make the curbside to make yourself more comfortable. It gets lonely out there.

It's not like you can confide in the patient. But every time I do mention clinical uncertainty, the patient is always grateful. Shows I'm keeping an open mind I suppose.

This profession tends to attract people who actually give a shit about other people. It actually impresses me how prevalent this is. Obviously there are really bad ones out there, and the profession doesn't do enough to get them out, but odds are good that if you're a reasonable person, your doctor will care about you.


Blogger Peg Spencer said...

Doc Nos - I just want to underline what you said about patients being grateful when you, how did you put it, "mention clinical uncertainty."

Patients are people too. I don't think they do expect us to know everything. They know we're human (even if some of us don't think we are!-present company excepted). I too find that patients appreciate it when I admit to NOT having all the answers. "I don't know" is something you rarely hear younger docs say, but I've learned not to fear it.

"I don't know, but I can find out," is what I tell them. And then I do. Or we do together.

Interesting post; thanks.


11:25 AM  
Blogger acumamakiki said...

Makes me feel a lot better knowing that.

11:46 AM  
Blogger marybishop said...

Do you ever watch House? I'm sure there's no doctor anywhere like him in real life...but what I do like about the show, besides the fact that House is the ultimate curmudgeon cranky doc -- he does think outside the box.

When doctoring can fit into a computer program...then it's not doctoring...I can look things up on the internet...that doesn't make me a physician...it's knowledge, experience, training and *intelligent thinking* that takes medicine from textbook to an art form...

How docs deal with patients will always amaze me -- looking at ugly things; dealing with nutso people, seeing death approaching and knowing there's nothing you can do to stop it. That takes a saint...

5:03 AM  
Blogger Peg Spencer said...

I love "House"! Not because of the medicine - every patient they see has some bizarre totally rare thing - but because of House himself. His behavior is appalling, but funny because he says things we all think but don't dare say. Also, I believe that under his crust there is a core of mush and caring somewhere.

There are clinic days here when I wish House would march into the waiting room and say, "Hello sick people! " and follow it with one of his caustic wisecracks that would clear the waiting room.

Doctors aren't saints. We're people. We learn to deal with those difficult things by doing it, either well or badly, but always learning how to do it better the next time.

10:25 AM  
Blogger Doc NOS said...

I've only seen one episode. I don't get TV reception by choice. Best choice ever. I watch movies, read, blog, write, work out. It frees up so much time!

And TV is so stupid! I only miss out on about 5%?

7:55 PM  
Blogger marybishop said...

Peg, he's the exact doctor I'd want to see if I ever went...no pussy-footing, no euphemisms...I would hope though, he'd not have just popped a dozen Vicodins...Do you know what happened to his leg?

Doc --Most of TV is awful...no question. Still I want to know what's out there...Don't you want to check in and see what those eegits of Fox are saying? I tune in to O'Reilly so I can keep my hate level up to a healthy level.

2:26 PM  
Blogger Peg Spencer said...

Wow, doc nos, no TV?! Good for you!

I didn't have TV as a kid until high school. Great choice my folks made.

There's a lot of crap but some good stuff too. I don't know how people find the time to watch hours a day, though.

Mary - I don't know what happened to House's leg (motorcycle crash?). Did you know the actor is British? He had a great acceptance speech at the Emmys.

3:57 PM  
Blogger marybishop said...

No Peg, didn't know that, but I was watching a movie with young relatives 3 - 5 age..and there he was...dressed like a goof and playing a simplton/sap role, and I couldn't believe it was the same guy.
I struggle with the fact that I now own more books, movies and music than I can ever live long enough to hear, read, see....

sad - just isn't enough time on this planet for people who want to hear it all, see it all, know it all...

We'd be monkeys if we tried to do the above ;-)

11:27 PM  

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