A Country Doctor Writes:

On today’s KevinMD, Kevin Pho is featuring a post I wrote this January on the occasion of the 46th anniversary of my first day of medical school (described in detail here). This post touches on E&M coding and the silliness of some EMR templates, but it still ends with my honest conclusion “I love my job.”

It became clear to me that my desire for a career in medicine was because it would allow me to teach, coach, explain, motivate and guide fellow humans in medical matters. I never fantasized about heroic procedures or brilliant diagnostic victories – I have since understood they are usually a little too infrequent to sustain a doctor week after month after year.

“Helping people” is often cited as a motivator for becoming a physician, but I don’t think that is precise enough. “Repairing their body parts”, “comforting them and relieving their suffering” or “helping them understand their options” are more likely to translate into professional satisfaction.

In today’s medical practice environment, there are plenty of opportunities to do what I enjoy the most, and I receive plenty of positive feedback for doing it. My favorite compliment is probably “Nobody has ever explained it like that before”.

Read on KevinMD: https://www.kevinmd.com/blog/2020/10/meet-the-physician-who-loves-his-job.html

My Swedish morning paper has an interesting article that ties in with recent pieces in the New York Times and other US media.

The so-called “Dark Triad” of personality traits was described by Paulhus and Williams in 2002 – narcissism, psychopathy and machiavellianism. They are strongly linked to lack of empathy. This triad, according to Svenska Dagbladet, helps explain the animosity and violence expressed and perpetrated by Covid-deniers in the United States, who value their freedom not to wear masks more than the health of their fellow human beings.

The Swedish article writes about this 18 year old concept:

“But since the world was paralyzed by covid-19 this spring, the dark triad has become relevant again. A number of researchers have studied how our dark features are linked to how we acted during the pandemic. A few, albeit relatively small, studies indicate that people with strong dark features to a greater extent ignore obeying instructions during the pandemic.”

Media here are full of accounts of the violence the non-believers are capable of inflicting on those who are trying to protect their own health and others, too. This is perpetrated under the guise of protecting their own individual freedom, denying everyone else the freedom to avoid exposure to illness and death. I personally find this divisiveness in our society frightening and disheartening.

In just two examples from today’s news, an 80-year-old man was killed at a bar for asking another patron to wear a mask and the president is urging his supporters to ignore the risk of dying from Covid-19.

NYT has a piece about cognitive dissonance and the virtual bubbles Americans live in when it comes to where we get our news (Fox versus the older TV networks, for example), describing how our brains “will go to baroque lengths — do magic tricks, even — to preserve the integrity of our worldview, even when the facts inconveniently club us over the head with a two-by-four”.

We live in a divided country regarding race, climate, and so many other things. Not that I actually imagined living in a time of a worldwide pandemic of this magnitude, but I would have thought if anything could have united us, that would have been it.

I was wrong.

The arguments about nominating a new Supreme Court justice have illustrated how relative everything really is around here.

Since our Constitution is still being reinterpreted after all this time and since Roe v Wade may be reversed, depending on one 48-year-old woman’s opinion, is there any wonder why not all doctors think and act alike?

There may be laws of physics, although I don’t think all of them are immutable anymore, but there are hardly any laws in medicine. All we have to go on are data and differing interpretations of what to make of it.

It should be obvious that much of what we do in medicine is far from straightforward or universal. All we have are broad stroke images, rough ideas, of how our bodies and biomes work. Right now, as we struggle to understand how one virus differs from another, we look back and realize that some patients with Covid were dying because they were put on ventilators – and there we were, thinking we wouldn’t have enough of them.

Medicine is like a society without sophisticated laws; a culture, clan or cadre of practitioners with scientific training, intellectual curiosity and open-mindedness as well as a required amount of humility, because we are constantly navigating in uncharted and ever-changing waters. And this society is built on just a few principles, perhaps outlined best—but certainly not legislated—in the Hippocratic oath.

We face two obvious dangers: trusting our own knowledge too much and trusting conventional wisdom too blindly.

Most people think you need to be very smart and experienced to sit on the Supreme Court—or any other bench for that matter—even though the laws of the land may seem like they should be self-explanatory. Imagine how challenging it is to always be an effective physician. But is that how my profession is viewed right now?

No, we are portrayed as followers, rather than interpreters, of the science. But the truth is, we often face unique situations where there are neither laws nor good science to guide us.

And as the physicians treating our ailing president seem to be making unusual or even inexplicable treatment decisions, it should be obvious how inexact the art of treating individual patients really is.

Interviewing celebrities can make you a celebrity yourself, and it can make you very rich. So there’s got to be something to it or it would be a commodity. The world of media certainly recognizes the special skill it takes to get people to reveal their true selves. 

At the other end of the spectrum of human communication lies our ability to explain and also our ability to influence. These three aspects of what we do—elicit, explain and influence—are far from trivial, and in my opinion quite fundamental aspects of practicing medicine.

….

The problem with our work environment is that all the technology and all the well meaning efforts we are subjected to have, ironically, conspired to distance us from our patients and made us less effective than we could be.
— Read on thehealthcareblog.com/blog/2020/10/02/physicians-communication-skills-are-overlooked-and-undervalued/

Kevin MD is running a piece today that I wrote a while back and had a lot of fun with, comparing the practice of medicine to childhood games like where’s Waldo and whack-a-mole.

After reviewing this one office note, my brain was exhausted. I had not expected the chart review to be so much more like Where’s Waldo than Who Dunnit.
— Read on www.kevinmd.com/blog/2020/09/wheres-waldo-finding-whats-important-in-the-medical-record.html