Literary H&P

Medicine is about storytelling. In particular, the medical history and physical (H&P) is an exhaustive write-up of the current status of the patient, with a strong emphasis on the events leading up to hospital admission. However, it leaves little room for creativity or narrative flair.  Here, excerpts from medical H&P write-ups in the style of famous authors:

Jane Austen
It is a truth universally acknowledged that a man with diabetes, hypertension and a history of smoking must be at high risk for cardiac events.

JKR
Mr. Ruiz, a lifelong resident of Brooklyn, was enjoying his usual state of health until one week ago, thank you very much. He was the last person you’d expect to experience dyspnea, since he was rather proactive regarding his health.

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Filed under Literature, Storytelling

Humanism in Perspective: Connectedness

At the end of the day, Humanism is about the recognition of the connectedness of all things. As I see myself in the trickling water of stream and the freshness of the morning dew, while having empathy for others, I see myself wounded by their suffering.

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Filed under Humanism in Perspective, Uncategorized

Lessons in professionalism, brought to you by Modern Family (spoiler alert)


This week’s return of Modern Family on ABC (“Lifetime Supply”) has a striking lesson about medicine amid its comic subplots. Phil Dunphy, father of the family, reports to his doctor for a check-up where pain is found under his arm. The monosyllabic doctor looks concerned and wants to “just run a couple of tests to be safe.” He says he’ll call Phil if anything is wrong.

The next day, Phil misses a call from the doctor. Immediately, he assumes the worst. The doctor said he would call if something was wrong – and he did call. In the next scenes, played for laughs, Phil thinks about his own mortality while he struggles to reach the doctor.

Separately, members of Phil’s family become suspicious of bad omens and acknowledge that calling a patient on a Saturday is unusual.

Fast forward to when Phil finally speaks to the doctor. Instead of informing Phil of imminent death,  he asks about a real estate listing.

“Yesterday, you said you’d call if something was wrong. Then you called. Then you disappeared. That is the most irresponsible, unprofessional thing I’ve ever heard of in my entire life.”

Pretty raw, despite the next few funny lines. Any viewers who’ve waited for test results know the agony of silence, and Phil’s words resonate. It’s worth remembering that tremendous fear and anxiety can arise from seemingly trivial comments from doctors.

Meanwhile, it’s a relief that Phil is well. Thanks, Modern Family.

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Filed under Humanism, Professionalism

What aviation can teach us about medicine

Two hundred years ago, the only noninvasive visualization afforded to doctors was through the stethoscope. Today, our CTs, MRIs and other technologies offer unimaginable insight. The danger is, do we know what we’re looking at?

The tragic tale of Flight 447 should not only be a case study in aviation but also in medicine. Medicine is becoming less of a hands-on science and more dependent on sophisticated tests and high-tech scans. As in aviation, there is an overall benefit; diagnosis and treatment are better than ever. But the same problem bedevils medicine, perhaps more commonly — in difficult situations, inexperienced doctors are often uncertain of how to interpret sophisticated information presented to them, resulting in incorrect diagnoses or inappropriate treatment.

Read the whole piece by Cory Franklin, MD, in the Chicago Tribune.

via drwes

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Filed under Technology

Healing, panel by panel

Remember all those times when Lois Lane couldn’t understand where Clark Kent was running off to? Secret identities have been the crux of superhero struggles since the inception of comics. Time and again we’ve seen comic book heroes grapple with misunderstanding from those around them (Professor X’s school, anyone?) and balance the need to blend in with being true to themselves. That’s why it’s really no leap at all to envision invisible disabilities, like Asperger’s Syndrome, in a similar way.

In New York city, a homeless woman with Asperger’s Syndrome has created a comic exploring the identities and struggles of high school seniors on the spectrum, entitled An Invisible Disability.

Ms. Hawkins had always found escape in drawing comics. And she had talent. An eighth-grade teacher made one of her cartoons into T-shirts for the whole class. She got into Art and Design High School and then briefly attended Pratt Institute. As an adult, she did fewer drawings after she smuggled her portfolio into a comics convention and pushed it into the hands of the legendary Stan Lee. He never called.

Hawkins’ comic, Asperger’s Syndrome: An Invisible Disability, will be on display at the New York Public Library through this Friday, December 30.

via nytimes

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Filed under Arts, Comics

Anatomy – A New Frontier

Gross anatomy is exactly as it sounds. You learn anatomy, and smell gross afterwards. You spend 6-8 hours the day before studying and preparing for a 2-hour dissection the next day. When an exam approaches, you double the 6-8 hours each day and sometimes forget who you, your friends, and family even are. Not to mention the perpetual question, “Why am I doing this?”

A portfolio of watercolors by Danny Quirk, aptly named “Self-Dissections: revealing the inner self,” remind me of why anatomy is fascinating. Quirk is a photorealist painter depicting scenes which the “camera can’t capture,” and he sure does.

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Oh, the people you’ll meet – Medical Student Edition

The third year of medical school is definitely an interesting one. You leave the classroom and enter the big bad world of medicine, and you quickly realize that much of what you’ve learned is for naught. You also realize that the medical student next to you could become your best friend, or the bane of your existence- or fall anywhere along that spectrum. Here is a list of the medical students you might encounter. This list is in no specific order, and in no way complete—feel free to add more in the comment section. And for the sake of simplicity, all of the medical students listed will be male. Sorry ladies.

1) The New Best Friend:

It’s your first day on a new rotation, and you groan when you see the other students listed with you. You barely recognize any of the names. How could you have gone through two years of school together and never talked? You fear for the worst. But your fear quickly turns into unbridled joy. This mystery man is both a gentleman and a scholar. He laughs at all your jokes, and sneaks out of the hospital early with you. You both help each other whenever possible, and by the end of the rotation, you’re planning to grab drinks together after work. You wonder where this person has been your whole life.  Sadly, like all things, this rotation will end. And your new best-friendship may end as well. But it was great while it lasted.

2) The Houdini:

The Houdini is, for lack of a better word, a magician. His patients are always the easiest to take care of, his resident never makes him do scutwork, and he manages to leave an hour before the rest of you. He shows up late half the time, but no one ever seems to notice. In fact, the Attendings love this medical student and praise him for his efficiency. As his companion, you find yourself envious- you wish you had his skill, but you know you’d be caught if you tried any of his stunts. You try to make yourself feel better by saying, “At least I’m getting more out of this rotation,” but deep down, you know that’s a lie.

3) The Future _____:

This medical student is really itching to go into the field in which you are currently rotating. They ask a ton of extra questions, beg the attending to go into detail on every disease, and try to follow the residents around as much as possible. They also have a never-ending optimism about them that quickly grows tiring. They may even ask for extra assignments, not realizing that all of the students will get extra work, not just them. And when the students are sitting around in their daily gripe-fest, complaining about their days, they’ll say something like “Oh c’mon guys- it’s actually pretty cool.” I’ll be honest, I’ve acted like this before. To a small extent. But c’mon guys- surgery is actually pretty cool.

4) The Gunner:

Now, the word gunner is frequently used in the medical student community. It is meant to describe a student who tries to advance himself at the expense of others. It is also used to portray those who study very hard by themselves, or basically any student who’s smart but kind of a jerk. The word is adaptable. On the floors, a gunner is the guy who looked up the vital signs for every patient on the service, and when you can’t remember your patients’, he says them out loud. He’s the guy who manages to scrub into all the cool surgeries, often by following around the attending physician non-stop. He’s the guy who refuses to go home when the residents dismiss everyone, and asks to do extra menial tasks. And when you ask him what books he’s using to study, he’ll proudly tell you how he “read Blueprints and First Aid and Kaplan and Pretest and I only did the UWorld questions twice, do you think that’s enough?” He’s basically begging for someone to trip him while he walks down the hallway. The only advantage of having a gunner on the team is that it unites the other medical students- it’s almost like how having a mean coach can pull a sports team together. Continue reading

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Filed under Education, Heard on the Floors, Hidden curriculum

How Doctors Die

With the Baby Boomers now entering senior citizenhood, almost all future doctors will be, to some extent, geriatricians. It’s no wonder that discussions of end-of-life and advance care planning now figure heavily into medical education and policy discussion. Today, patients are encouraged to complete advance directives and are informed of risks, benefits and alternatives at every point in their care. Why then, do doctors themselves make such different decisions from patients in similar situations? Ken Murray, MD, an Assistant Professor of Family Medicine at USC, discusses the way that physicians approach end-of-life.

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

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Filed under Chronic illness, Policy

Back to the future

We frequently hear humanism in medicine discussed as though it’s a new trend in medical education. Yet back in 1986 (before many of today’s medical students were even born – yes, really) an “Education Watch” from the Times called attention to this new element of medical education.

A recent survey by the Association of American Medical Colleges showed that 112 of the country’s 126 four-year medical schools now require students to take courses in doctor-patient relationships, communication skills and cultural, social and ethical issues. ”If we had done the survey in 1970, we would have found none of these kinds of courses,” said Dr. August Swanson, the association’s director of education.

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Humanism in Perspective: Feedback

A few months ago, Atul Gawande wrote about the need for surgeons to be coached and receive feedback, much in the same way a professional sports player is groomed. Here, Dr. Dorian Wilson from the Center for Humanism at NJMS reflects on a similar theme.

I call it DA: Developmental Arrest. Physicians have a subtle malady to which they are prone. In my mind, the proclivity toward this malady goes something like this:

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Filed under Humanism in Perspective, Physician authors