Modern Medicine

August 10, 2005

Modern medicine, with all its new-fangled technology, can answer many questions once thought incomprehensible. Whether or not you can really love a larger woman isn’t one of them, but I was thinking about that yesterday at a barbecue with my neighbor Ted and his kids. His wife is “plus sized,” to put it politely, but she’s attractive and I’ll admit to having contemplated her on occasion.

Dr. Mort Kandless

Anyhow, I recently spent a month on the wards after recuperating from an unfortunately placed case of shingles (I’m walking much better now, thanks). A third year medical student was presenting the case of a Mr. L.G., who had suffered a sizable myocardial infarction that masqueraded as indigestion. This poor guy sat at home swigging Maalox while his inferior wall bit it hard, and some son-of-a-bitch cardiologist lost out on a few thousand dollars he could have gotten for roto-rootering a clogged circumflex.

So this third year student says that L.G. has a friction rub and he wonders if the guy might have a pericardial effusion. “Hmmm,” I say, in a really wise sort of way, like I’m going to create the eleventh commandment. Wouldn’t you know it, just at that moment, my AM post-prandial bowel movement crept up on me and I had to take a meeting in my “office.” Upon my return, I ask the residents how we might assess Mr. L.G. for a pericardial effusion. “Let’s get an echo,” said Meyers (that’s not really his name, but it’s a good one for a doctor).

Therein lies the trouble with technology: it turns our young physicians brains into cream of wheat. I then asked the team how we could assess this problem if it were, say, 1952. Meyers asked if there were pericardial effusions back then. I have since recommended that he be terminated. But one bright light in the group did say “maybe we should check a pulsus paradoxus.” Way to go Latin boy. At least he read the book once. Not that he knew how to measure it, but he was on the right track.

Physicians’ reliance on technology has worsened their clinical acumen and increased utilization of resources to the point that you can’t set foot in the hospital or doctor’s office for under a couple large, if you know what I mean. And who benefits from this? The freakin’ radiologists, that’s who. Which brings me to my overall point here, which is that internists need to prove the value of their cadre of “procedures”. Checking a pulsus paradoxus or assessing for Kernig’s or Brudzinski’s sign, for example, should be the bread and butter for any internists viability. And such procedures should be reimbursed at, say, $1799.00 or so, each. Don’t you think I’d like to have a nice boat too? Meanwhile I can’t even afford my kid’s summer camp.

Oh, and about the clinical acumen, that’s the greater benefit, in a sort of existential, but much less tangible way. So start perfecting your physical exam and diagnostic skills, and before too long you won’t need any of those high tech gadgets to care for your patients. And maybe some day you’ll find yourself booking whole afternoons for Hall-Pike Maneuvers and rolling in it all the way to the bank.

I’m Dr. Mort Kandless and ... That’s what I think.

Remember: Quality Without The Q Is Just Uality!