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10 Reasons To Be A Doctor

With all the negative press, the pay cuts, and the uncertainty of healthcare reform, I am approached by people who secretly whisper in my ear, “Would you have your child go into medicine?”

On first blush I am tempted to answer, “Heck no!” given the administrative hassles, the changes in the public’s perception of our profession, the frontload of education, and the long hours involved. But those observations, while real, are superficial at best.

Drilling down with more careful analysis after a challenging weekend on call, I find it worthwhile to stop and ask myself what makes medicine special for those of us crazy enough to subject ourselves to this lifestyle. I decided to put together a list of things that were important to me and would welcome additions from others.

10. Independence – No matter what happens on the larger public policy and procedure scale with guidelines and mandates, when it comes to decisions regarding a patient’s care, it will always be the one-on-one interaction between the patient and the doctor that will ultimately decide the best approach for care for an individual patient.

9. Respect – The title “Doctor of Medicine” still carries weight in our society. With that respect, however, comes significant moral imperatives to maintain that respect.

8. Flexibility – For those not adept at one-to-one interactions with people (hence, the clinical side of medicine), there are a myriad of opportunities opened with the MD or DO degree in public policy, research, the basic sciences, journalism, consulting, business, etc. It is this flexibility of options that are open to doctors that ensures job security.

7. Variety – I have been doing medicine a long time and have yet to see two days’ activities or two patients that are the same. Ever. Bottom line: Medicine is never boring.

6. Influence – Physicians matter. People know it. But you’d better be ready to be cornered at cocktail parties.

5. Reward – I cannot not think of anything superior to helping a fellow man or woman at a time when they are most vulnerable or in the greatest need. It also occassionally provides upgrades to first class when you help treat a syncopal patient on an airplane.

4. Trust – Like Smith Barney says, you have to “earn it,” but once a patient’s trust and confidence, it’s the tie that binds. By virtue of your title, you are invited into the most secret parts of patients’ lives to share their deepest concerns — a truly remarkable privilege. Corporate meetings never leave me with that feeling, if you get my drift.

3. Humility – Medicine will always keep you humble since there will never be a time when you can know it all or cure it all – ever. It’s both the blessing and the curse of our profession: the learning never ends.

2. Fascination – Every day we work with the most amazing technology imaginable. The wonder of it all never ends: ask anyone who’s ever reached in an abdomen to remove ischemic bowel, prescribed an antibiotic to cure a pneumonia, or ablated an tachycardia that affected someone their entire life and rendered it of historic interest only. Even something as simple as cutting the skin with the belly of a 15-blade scalpel while listening to the patient chat idly about their grandkids thanks to remarkable local anesthetics during a pacemaker implant, you are reminded of the amazing wonders of modern medicine every day.

1. Teamwork – Medicine is, by definition, a team sport. No physician can do what we do in isolation. Our “Club Med” has challenging pre-requisites, but once in, it is a vocation where we share collectively in the trials and tribulations of patient care. We win and we lose, together. Whether we are doctors, nurses, technicians, administrators, clerical staff, safety personnel or maintenance workers — each of us are constantly working for a common goal, which is the health and well-being of our patients — and when it works, nothing, I mean nothing, is as cool as that.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

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