It ain’t always pretty – a recollection

2

Category : General, Medical Rants

Cleaning Up the Mess of Medicine in the Pages of Posterity

As I headed up to the laboratory to deliver our hard-won tubes, it occurred to me that in the event our patient proved to have some unusual infection and we wrote up his case for a medical journal, the last surreal 30 minutes would be immortalized in print as follows: “Cultures were obtained.”

Medicine has two faces: the iodine-stained, glass-splintered messy reality we all work in, and the clean, quiet, dignified prose we use to record it for posterity. No absence of order penetrates our documents of record. The journals’ glossy pages – or, now, neat online screens – are serene and pristine, rational and assured. Every study has a conclusion. Every case has a diagnosis. Every necessary test is performed, without fuss or muss.

If there has been any drama finding a vein, or cajoling a claustrophobic patient into the M.R.I. scanner, or debating a practicing pagan who is refusing his blood tests because the moon is waxing gibbous, you certainly aren’t going to read about it in the literature. Yet, it all happens, all of that and more.

Back in my days of predawn shivering, I figured that once training was over, life would become as orderly as it was in the journals. It was a delusion born of sleeplessness: medical reality always diverges wildly from the printed record. Drugs often don’t behave the way they do in studies, and patients almost never do. Labs make mistakes. There is an unending parade of problems for which the received wisdom holds no answers.

Sometimes I think the oasis of the medical library should be maintained as a pleasant and essential refuge, mirage though it may be. Loose ends are all neatly tied there, and every chart flows nicely down the page. Like the mythic Jerusalem, city on the hill, it inspires us all.

Sometimes I think it’s a disgrace and a lie. Why not tell it the way it is, for a change? Let journals immortalize all the messes and foul-ups in print, the spurious lab results, the problems that never get solved or the ones that seem to solve themselves despite us.

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Comments (2)

I had an experience like that today with a recheck of a 20-year-old for dysfunctional uterine bleeding. The visit lasted twenty minutes. I reassured her (for the third time) that the oral contraceptive was a standard treatment for a medican condition, probably didn’t interfere with her religious beliefs, and would not affect her future fertility. It took ten minutes of history extraction from me and my attending to figure out if she was taking her placebo pills or not and what her period was like, exactly. (“It comes on when it wants to come on.”)

I had trouble finding much more to write in my assessment and plan, and settled on “Ortho Novum controlling symptoms well. Will continue and recheck in 3 months.”

[…] Yesterday I cited a NY Times essay on the messiness of patient care – It ain’t always pretty […]

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