Doctoring Health Care Health Care Reform Reflection

Don’t take my fun away

“Did you sign those (three) consents?”

“This patient needs a short form; your office letter was done 30 days and one hour ago.” (just over the legal limit)

“The insurance ‘people’ in area code (***) denied the stress test.”

“Mr Smith’s son, an alternative medicine specialist in California wants a phone call to discuss herbal therapy of AF instead of ablation.”

To these, and the infinite list of similar hassles, I have been responding with a new plea, “Please don’t take the fun out of doctoring.” Saying it out loud, like a childhood prayer, reminds me of the truth: that doctoring is, still, a really a great job.

This week two unusual things happened to me that reinforced this truism.

First, an internist called me to say there was a near-100 year-old that had heart block requiring a pacemaker. She is an enlightened doctor and knew my gut reaction, so she quickly added, “this patient is a good 95, we’ve already been there.”  And then she said one more thing, “I have a fourth-year medical student who is rotating with me…can she come watch? I have no idea how a pacemaker is installed, maybe you could show her, and she could tell me.”

We are within only a scant few miles of the university, but yet a Berlin-wall-like barrier seems to exist between the private world and the university. Every once in while though, a “younger” escapes on some elective rotation. They are sent out into the deep dark forest of the private practice world. Such escapees are always young, and as time passes they appear even younger.

To us non-academics, there is nothing quite like having a motivated youthful escapee to listen to your show-and-tell. She had never seen an EP lab, a cephalic vein isolated, a simple peel-away sheath, or a pacemaker lead. Who knew that basic physics 101–the flow of electrons–would apply so directly to patient care.

“While she was there it wouldn’t hurt to show her some more stuff,” I thought.  Then there was a cardioversion.  So simple to us, so ‘shocking’ to the fourth-year medical student, who jumped a little with the patient. “Ok, it’s time to go, I know you need to get you back to your primary care rotation.”   But on the way out the young escapee peered into the interventional lab, as if to say, “what’s going on in there?”  So we went in, to see the “squishers.”  I am not sure what impressed her more, the visual-only miracle of a 90% blockage being reduced to nothing, or the fact that the doctor was passionately chastising the ‘versed-ized’ patient on the dangers of persistent smoking while he squished.

“Dr Mandrola,” whispered a cath lab nurse, “I think I like having medical students around too.”

The second occurrence was late on a Friday, as I was rushing through the usual Friday-afternoon feast of documentation.  He was interviewing for a job, and I was to be talked with about our medical community. He was just out of training at a major university in a major city. He was young, with small children and a wife who was a doctor as well. He asked about our medical community, and whether I was happy.

I started to talk, and a surprising thing happened: only the good things seem to come to mind. Not that I was trying to bamboozle him, but, the ‘cubicle-doctors,’ the forms, the pharmacy requests and even the covert rationing of care were all suppressed, in an involuntary way. The joy of doctoring came to the fore. Truths like: we have hard-working, good-hearted and well-educated colleagues (nurses and doctors) to work with, we have the support of a benevolent (if not increasing stressed) hospital administration and mostly, we have many grateful patients. I stayed and talked later than I should have. Because it felt good to reflect on what is still right with the system.

My academic colleagues interview incoming prospective faculty and students frequently, and as part of their charge, they get to show neat stuff to youngers every day. I’m envious of this, for sure.

Such opportunities for reflection (on what is so good about our profession) are less common on the speedy private-practice treadmill.

So when they occur they should be savored.  Writing them down helps me remember.



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