Google Images gave us a map,
And a place for the patient to tap,
But the name of the nerve
Threw me a curve
But I’m good at using the app.
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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with more travel and adventures in temporary positions in Iowa, Pennsylvania, Nebraska, Canada, and Alaska. 2019 included hospitalist work in my home town and rural medicine in northern British Columbia. Since the pandemic started, I did 10 months of telemedicine in my basement, staffed a COVID-19 clinic in southeast Iowa, visited family, attended funerals, and worked as a contractor for the Veterans Administration in South Dakota. I currently hold a part-time position in northwest Iowa, reasonably close to home.
The patient came today with a very strange symptom. I listened without interrupting. I said, “So if I’ve got it right…” and repeated back the history.
I had never heard of such a problem, but I went to Google Images, and pulled up a nerve map. I showed it to the patient, and said, “OK, point to the area of the problem.”
I came up with the name of a superficial nerve I don’t think I ever learned during neuroanatomy in medical school.
I called the specialist, a doc a good 10 years younger than me. He had never heard of that nerve, either. But he muttered to his office staff then returned to me and said, “Just send the patient over.”
Which I did.
Contrast is still the essence of meaning, and the ease of the interaction made me think about an experience earlier this week when two specialists successfully dodged a referral. I ended up wasting 45 minutes till a Family Practice doctor ended the problem, but the episode left me thinking.
Every generation of physicians accuses the next generation of not wanting to work.
My father got his training at a time of different expectations: medical school, a year of internship, hang out a shingle and work 24/7/365 till age 65, then retire and die 2 days later. At that time most docs did appendectomies and hernia surgeries on their own patients, and attended them for hospitalizations.
I think Dad accepted my not doing surgery, but he looked askance at me sharing call with 5 other docs.
I kept attending my hospital patients till well into this century. Each passing year finds fewer docs doing so as the hospitalists take over inpatient care. In fact, the US (and, less so, Canada) are the only industrialized countries where outpatient doctors take care of hospitalized patients.
For the younger physicians, hospital avoidance ranks as a quality of life matter; a full service doctor cannot ever hope to achieve a work-life balance, because taking call effectively doubles the number of hours of vigilance, emotional unavailability, and temporal undependability for the family.
Yet these two things will not change: Sick people want to get better, and they don’t want to be surrounded by strangers.
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