Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, October 26, 2006


What the hell am I doing with my life?

Here I am, babysitting anxious suburbanites afraid they're having heart attacks or dying of Lyme disease when all they have is muscle pains and achy joints from overdoing their version of "exercise." Trying to talk overweight forty- and fifty-somethings into taking statins to lower their LDL cholesterol of 165 after three years of "trying" diet and exercise, because there are guidelines that say it lowers their risks of MI and stroke. Explaining to diabetics why a blood pressure of 120/80 isn't good enough, again, according to all the latest that evidence-based medicine has to offer. Feeling pretty good when I diagnose a basal cell carcinoma instead of the ringworm the patient has been treating for two months. I spend an entire day doing nothing but giving flu shots.

And so on...and so on...and so on.

Then I come home and log on to my computer, where I read things like this:

People who hunt because they have to. (My version of stocking up on meat is going to Costco.) Villages who gather for funerals. Places where life and death seem more real than the Philadelphia burbs, where folks folks carry on about Flyers and Eagles as if putting a small piece of rubber into a net or getting a leather balloon over a line really means a damn thing at all.

People who tend caringly to a woman who has just lost her baby -- not because it's actually their job, but because there's no one else to do it. People to whom HIV "post-test counseling" is the emotional equivalent of a diagnosis of cancer -- not quite a death sentence, but just about. (Do you know how often I've seen a positive HIV test? Never. The only HIV patients I have came to me already diagnosed.) And these are medical students breaking this kind of news.

People who work 19 days straight; twice, with only a weekend in between. After surviving two strokes; who also have children and families and friends and all the other things I struggle with (never having had even one stroke; nor arthritis; nor anything worse than a fractured metatarsal that took a year to heal.)

I've never really saved anyone's life. The closest I've come to that was picking up ITP from a purpuric rash on a little girl and finding that her platelet count was 3. I sent her down to Children's for IVIG, where she did great. It's now 10 years later and I just signed her driver's permit. But to this day, her mother swears I saved her life.

I bitch and moan about how hard it is to make a living doing...what is it I do?
  • I called a lady back today to tell her she doesn't have mono.
  • I saw a man yesterday who was worried because the left side of his face felt hot -- as he was undergoing a work-up for transient blindness in his right eye several weeks before. His MRI was scheduled next week back home in the UK, and he wanted to know if it was ok to wait. I did a careful history and exam, found nothing, and told him it was.
  • A lady was worried because a mole on her leg was changing; it wasn't even an actual nevus.
I make people feel better.

What a crock.

And yet...

When I counsel and console people in pain who insist that they're not so bad off -- so many other people are suffering so much more than they are -- I validate their pain for them. I point out that pain is absolute; not relative. If you have a broken leg, it doesn't hurt any less just because the guy down the hall has two broken legs.

I suppose nervous suburbanites have as much right to reassurance and health maintenance as Yupik villagers have to basic (and not so basic) health care from amazing paramedics who also hunt, mush and mourn with them. I guess encouraging women to go for mammograms is a form of caring, even if it doesn't seem as profound as being the one to tell them it wasn't their fault their baby died.

So yeah, I'm a wonderful doctor. But oh, what a mediocre person I feel like today.


At Thu Oct 26, 11:20:00 PM, Anonymous Anonymous said...

Well, I must be all emotional today. Doc., I think you do alot more than you give yourself credit for.

You fight for your beliefs..Thats not a guess, or an assumption, I know that you do this. Example...All those women in Africa that you want to have access to Gardasil..

Don't you ever think what you do isn't important.. You need to get out of that frame of mind. Yes, you ARE a wonderful doctor!

At Fri Oct 27, 09:48:00 AM, Blogger Big Lebowski Store said...

We're not mediocre people, Dino, we have mediocre jobs.

It's a short step from validating somebody's pain to medicalizing it.

A much less mediocre job is spreading the good word about wellness and then helping to make it happen.

Another thing you could do is treat the stuff that doesn't need the specialist, and triage the stuff you can't fix.

There are more mediocre jobs than that.



At Fri Oct 27, 01:15:00 PM, Blogger Unknown said...

It's not the same, but I've been invited to go and work at a community clinic in South Africa where the children and adults don't have access to any asthma medications. Of course, they are the comparatively fortunate ones if they 'only' have asthma: the township in question has an HIV/Aids rate of around 60% in the adults.

If I can work it so that my family don't feel abandoned, and it doesn't cross up my application for an advanced degree programme next academic year, then I want to go.

Regards - Shinga

At Fri Oct 27, 03:35:00 PM, Anonymous Anonymous said...

#1 go get some really good chocolate and a hot cup of coffee, you'll feel better soon. I recommend Hershey's dark with cranberries and nuts.

What you do matters, however lightly you may consider it today.

PS- if chocolate doesn't work take a drive down I95 or the AC Expressway with your favorite music. The leaves are at peak and it is impossible to be petulant while cruising at 70 mph with music.

At Sat Oct 28, 05:15:00 AM, Anonymous Anonymous said...

I'm with cathy, #1 Dino, both as to being (maybe) overly emotional and to thinking that you're probably not giving yourself enough credit.

It reminds me of a conversation I had with my wife a couple of weeks ago. Background: Father of 3, full-time job, licensed EMT-B jonsing for paramedic school, going back to college to get an MD, active local emergency volunteer (CERT, Red Cross, amateur radio, counte Medical REserve Corps-man, etc). I asked her "Yeah, but what do I do though?" Her response was something to the effect of "you do all this stuff so that you can make things work when $#it hits the fan, so that you can help other people" and followed up with "You make it so that everything else can happen, when it needs to. Not just for our family, but for our friends and even people who will never know your name"

Talk about a wake-up call for me. Sometimes it's good (and useful!) to be smacked upside the proverbial head with a different point of view.

So, my advise is to listen to the positive words of the outside others. Chances are good that they see something that you don't.

At Sat Oct 28, 12:02:00 PM, Blogger MedStudentGod (MSG) said...


All the work you do is not mediocre to the suburbanites who count on you. You are trusted by people to take care of them and allow others to when it extends beyond your knowledge or skill level. That is something that most people will never actually experience.

Plus you have such wisdom to impart to those of us still struggling with our own confidence levels. I have come to rely on your words often when I write or through your own postings. Your having a bad day, but don't let that fool you into thinking that what you do holds little to no importance. It does.


At Sat Oct 28, 04:32:00 PM, Blogger The Tundra PA said...

Hey #1--

I agree with all the above commenters. Sometimes caring for the Worried Well can be more challenging than caring for the Actually Sick. When I see the fourth patient of the morning who has come in for a chief complaint of "I've got sinus" and the triage nurse has noted "times 2 days", I have to take a deep breath before I enter the exam room. Picking up ITP out of a hundred viral exanthemata is strong work! The challenge is not being lulled into inattention by the volume of commonality. What you are doing is important, for all that some parts of it may be mind-numbing.

If you'd like to inject a little additional stimulation into your practice, how about considering a two or three week tour of duty up here at the edge of the planet? You'll see lots of interesting stuff, and the pay is not bad either!


At Wed Nov 01, 11:21:00 AM, Blogger Wil said...

Having been a denizen of suburban Philadelphia, once upon a time, long, long ago, I submit you need to take one of your two days off per week and volunteer your butt in at an inner-city free clinic (or whatever they call themselves these days). There is a tremendous need right under your nose, if only you'd remove your blinders and get off the pity pot.

Heck, just take a ride some Saturday midnight through the streets of Camden! You'll get as much of an adrenaline rush as any moose hunter, assuming you make it out alive!


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