Why be a physician?

There is a huge bouquet of flowers in our living room, and they came from a patient.  Not a patient of mine, mind you, but one of my wife's patients.  Well not the patient herself, actually (we're both pediatricians) but the patient's mother.  We say this a lot about pediatrics - we never treat one patient at a time.  It's the individual with the medical problem (in this case a teenage girl) and the parents.  And, sometimes other relatives as well.

Back to the bouquet.  It was the result of a series of fortunate events.  An adolescent comes to the doctor with a sore throat.  The sore throat is nothing much.  The doctor performs a very good physical examination and discovers a mass in the pelvis.  It is a tumor.  Imaging is performed, a surgical referral occurs, the mass is surgically excised and it is benign.  It could have caused problems, nonetheless, if not tended to.  The patient is fine and the parents are extremely grateful.  If the emotional life of a physician were a bank account, and late night phone calls, insurance forms and missed family events were small withdrawals, then a moment like this one would be like a windfall, a huge inheritance from a relative you've never heard of.  Moments like this are one of the reasons we become physicians.

Then there is the intellectual challenge.  I was reminded some years ago that doing a good job as a diagnostician doesn't necessarily get you a bouquet.  I was seeing a little boy, probably four or five years of age.  He had a lump in his neck, in the space under the chin and on one side that we call the anterior triangle.  I obtained a history: how long has it been? Does it hurt? Any fevers?  Do you have a pet rabbit? Any travel? And a dozen other questions.  I was on a quest, and although I may not have been conscious of it at the time, I was rather enjoying myself.  This is what it is like to be a diagnostic sleuth, a real-life House.

And so, in an effort to be "informative" (but maybe just to show off a little) I heard myself reviewing a list of five or six diagnostic possibilities - what we call the "differential" in the jargon of Medicine - with the patient's mother, all the while writing out tests, a blood count, tuberculin test, various antibody levels and so on, that I recommended we obtain right away.  I felt very much in control of the situation and pleased to use a few more brain cells than are required to diagnose the common cold.

On the way out of the office, my nurse, a thirty year veteran, asked the mother in her typically kind way, "so is everything all right?  What did Dr. G. say?"  I was utterly surprised, but shouldn't have been, when the mom turned and said, "well, it seems he hasn't the slightest idea what it is!"

A dose of validation can do wonders for us, but a bite of humble pie is also therapeutic.  See you next time.