Trust vs Mistrust

A few months into my post-graduate internship, I bought a book entitled "How Doctors Think," which attempts to explain to the common people, how their doctor processes their feelings, complaints and diseases. Hard-pressed for topics as we bloggers are, hehe, I found the interest in the book quite amusing as fellow PGI's and residents alike have expressed their desire to borrow the book.

Anyway, what got me hooked on the book was the introduction on the book jacket that read that the common physician usually interrupts his or her patient during the initial interview a few minutes into launching his complaint.

It is true.

Too many times have I done it.

Too many times have I heard my fellow PGI's, my residents do it.

Too many times have I heard my consultants do it.

By doing this we want the patients to tell us something that will confirm that diagnosis we have in the back of our minds instead of listening to our patients' complaints.

Recently, we had a patient come into the emergency room in severe respiratory distress -- O2 saturation 30-40%, turning into this really scary shade of blue, no appreciable breath sounds. I called my resident and we got a history -- a known asthmatic, with multiple hospitalizations for asthma and a rich history of allergies. Apparently, from the mother's very words, a butterfly landed on his right shoulder as he was going to sleep. He started itching all over, gradually having a difficult time breathing and was rushed to the hospital.

Sure it sounds logical now -- anaphylactic shock. But at that time, in the ER confronted with that butterfly story (which was more likely a moth, with that really annoying powder), I refused to listen. I can't speak for my resident (but I think he didn't buy it either), but I kept thinking there is no way a butterfly could do this much damage. (Deadly brown and yellow butterflies, perish the thought of them terrorizing our flowers).

As we loaded him with steroids, shot him with epinephrine, bagged him until that shade of blue on his cheeks turned a light shade of pink, we noted a reddish elevated patch of skin around his right shoulder and eventually small pinpoint rashes came out. It was then we both admitted, my resident and I, "tinuod jud diay 'tong butterfly." So what the mother said was true.

It's a mistake we make often, not listening enough, to patients or not. Our generation of MD's have often been criticized as having lost touch with the art of medicine -- that we rely on new-fangled machines, laboratories to make our diagnoses rather than old-fashioned clinical sense.

I beg to differ.

We have the best of both worlds.

If we do not lose sight of how a good clinical history and physical examination goes with our laboratories and imaging, we will be better doctors than those that have come before us.

Let's renew our faith in our patients.

After reading that book, I may still interrupt patients and forgive me if I still do not trust them fully (given the barrage of late-night consults with really stupid complaints like incessant crying and a few-minutes-ago cough), I resolve to listen more and at most, give them the benefit of the doubt.

A Medicine State of Mind

Wow, my first post. I welcome me to the world of blogging (thanks Gaya). I write this fresh (I don't know if that would be the appropriate word since I am anything but fresh) from a 36-hour duty day from my current Pediatrics rotation at Silliman Medical Center. I'm tired, dirty, hungry and I feel the coming of a cold and probably contracted a strain of a gastroenteritis virus from my patients but I can't help but feel good at the same time. You see, I never really knew why I got into medicine. I guess I just felt at that time that it was the next logical step for a physical therapist who did not want to go looking for the money abroad. And it was the next likely challenge. There were moments during my PT internship that helped make that decision though -- like the time I helped my Spinal Cord Injury patient at Jose Reyes Memorial Medical Center stand and take his first steps, his mother came up to me and thanked me and definitely made my day. The time when I helped a 2 year old Cerebral Palsy patient achieve standing balance, the look in a stroke survivor's face when he can feed himself again -- all these small things brought a smile to my face and helped me enter the world of medicine. Since then, I graduated and currently I am in my 3rd to the last month of my postgraduate internship, and I have to confess, I have never loved medicine more than I have today. As corny as it sounds, It's helping others Healing Diagnosing illnesses Talking with people Having people trust you with their health and lives Having friends who share the same passion It's getting free food from sponsors for expanding your knowledge It's having guidance from venerable doctors who want to teach Mostly it's feeling that I am making a difference. It's feeling that God's healing touch works through me. As I end this first post, well, I've gotten used to life every three days (Duty every 3), the sleepless nights (though still happy and busy nights filled with noodles, pan de sal, and cafeteria cheese bread), and the lifestyle of medicine. It's something we as future doctors have to take in stride, a state of mind that we are His instruments of healing, and that in the course of doing our jobs, have time to smell the proverbial roses.