Thursday, February 17, 2011

The Lucky One


I'm home again after another amazing week in rural Maine. I gave my first tetanus shot yesterday and identified, if not actually diagnosed, my first case of outpatient pneumonia. The latter was a biggie for me since we didn't have a chest x-ray to rely on; instead, it was a matter of taking a careful history and listening to our patient's breathing, then asking what was the most likely explanation for their presentation. As I've mentioned previously, I can't get over how much more akin to internal medicine this rotation is turning out to be.

In part, this is due to the fact that my preceptor's patient population is, by and large, an older one, so the colds, flu, measles, and chickenpox that show up in family medicine don't walk through his door too often. It also stems from his comfort level, dealing with difficult and challenging cases. He won't admit it -- something I admire about him -- but he's a careful and astute diagnostician. He takes his time with patients and encourages me to do likewise and make certain I offer well-reasoned and thorough explanations for what we're doing and why.

More than accurate explanations, he wants to make sure we provide ones that are comprehensible. This appeals to me strongly because it's the same principle my friend Dr. Lynn Smith and I followed when writing our book. We wanted to communicate effectively, not impress readers with the extent of our vocabulary, something that often characterizes academic writing. "It's not what you say or do," my preceptor reminds me over and again, "it's what people think you said," that matters. For this reason, you want to make certain what they think is the closest approximation of what you actually said, as possible.

So, for example, when urging a patient to take a complete course of antibiotics and not stop once they begin feeling better, he'll say, "It's like wolves who attack the weak and sickly in a herd of deer and then go after the strong." An antibiotic kills off the weaker members of a bacterial population in the initial few days of taking it, but you've got to finish the prescription in order to get the ones that remain after you've started to improve. Makes a lot of sense, doesn't it?

I'm three weeks down in what's usually a four week rotation but I've been offered the chance to extend it by another two, and that's what I'm doing. I'm learning too much and having too much fun in the process to turn down the opportunity. Of one thing I'm certain, when I graduate, whatever kind of physician I'll become, it will be strongly colored by the weeks I've spent with this guy and his gal Friday in north central Maine. Am I ever the lucky one.


(Creative Commons image of the Kennebec River Valley by jimmywayne via Flickr)


6 comments:

  1. Hello Bill, Its great what you are doing..I hear a wonderful caring doctor!! Its hard not to speak jargon, but much better to be simple.
    I worked in a Pharmacy when giving up nursing earlier in life. I learnt so much off that pharmacist. He always told pt's to take vit c (250mg qid)when on A.B's and when they finished taking them to eat yoghurt with Acidophilus Bifidus to feed back the good gut flora. I believe this good advice considering those who take course after couse of A.B.s and are always sick. You are likely ahead of me and already teach this?
    Many doctors in Oz don't, they rely on the R.N. to educate the pts.
    You are making me miss my vocation. Many blessings are sent your way.

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  2. Hi Crystal -- thanks for the reminder! I had forgotten this little tidbit of wisdom. We always remind patients about the remote, 1:200 chance of C. Diff colitis when taklng any antibiotic, but the use of yogurt is a way of restoring that gut flora (friendly bacteria that live in our intestines and help us absorb nutrients from food, for the non-medical reader). I'll start passing it along next week! Thanks, Teach! :-)

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  3. It goes to show the simplest things can have the greatest impact. :-)

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  4. Bruce is a C.Diff survivor (2005). Maybe this will convince him to eat yogurt. Hope springs eternal. :)

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  5. C Diff is nasty stuff and well worth avoiding -- a little yogurt goes a loooong way. :-)

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  6. Stoneyfield has a nice chocolate yogurt, by the way, if that will sweeten the deal. :-)

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