We started out doing rounds
Exploring our intellectual bounds
It’s not a misnomer
To call a vomer a vomer,
No matter how silly it sounds.
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent last winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Just finished with 2 months in western Nebraska at the most reasonable job I’ve ever had, I am back in coastal Alaska. Any specific patient information has been included with permission.
Yesterday before 10:00 AM I had to research two diseases I’d never heard of before, and I didn’t attend a patient with either.
Medicine uses its own language. Some nouns, like vomer (the midline bone in the nose) have no other synonym. Ideally one could discern the nature of a disease by its name; viral hepatitis, for example, means liver inflammation caused by a virus. But if we call a malady by someone’s name, such as Parkinson’s disease or Lou Gehrig’s disease, we say that we use an eponym. And we call it a misnomer if the disease isn’t what we call it, for example, a pyogenic granuloma is neither pyogenic nor a granuloma.
Another provider held up an x-ray report and pointed to a term, asking if I’d ever heard of it. I chuckled and asserted that surely the transcriptionist meant either fracture or infarction instead of what appeared in black and white, infraction. So I looked up the eponym, only to find that the transcriptionist had typed correctly.
The other term, including an Alaskan place name, got thrown around during rounds. I had heard of the body of water, but not the syndrome.
The medical staff gets together every morning, much as we did in Barrow and each meeting makes me a better doctor. We talk about admissions, births, deaths, and interesting cases.
For the second time this week, we threw the term Wernicke-Korsakoff around without making that diagnosis.
When we talk about what might be wrong with a person, we use the term “differential diagnosis,” meaning the things that could give rise to a particular clinical picture. In conversation, we shorten it to “differential.” In the process of dialogue, we draw on each other’s experiences and knowledge at the same time we go through our reasoning process.
After rounds I nipped out to the airport to pick up Bethany, then I came back to find that I had drawn the position of second call: help out the first call doc if overwhelmed, and take care of radio traffic.
The term radio traffic qualifies as a misnomer because we use telephones where previously radios had done the job. Dozens of villages look to the town as their hub for business, health, and air travel. Every village has a clinic staffed by a Community Health Aid or a midlevel practitioner. Each permanent doc serves as consultant for more than one village, but the second call physician converses with the clinic when the assigned doctor goes on vacation. And right now the hospital finds itself short-handed.
I sat in the medical staff office. I cleared up documentation and read through the scores of emails that had arrived before I did. I looked at the corporate website, and checked weather reports. I read through some informative threads on Sermo.com, a doctors-only website. At noon I went to a Continuing Medical Education lecture on diabetes and the new class of drugs, incretin analogs.
At one I had a few phone calls, and I phoned around to a dozen clinics.
And I drew on my experience with game theory to make decisions based on incomplete and imperfect information.
I did a necessary job, but I prefer face-to-face human contact.
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