And, in yet another exciting edition of, "What they taught me in medical school turned out to be completely and utterly wrong:" open ended questions.
I was listening to the medical students talk about a patient interviewing class that they take every year. It's a pretty standard kind of thing. The student interviews a standardized patient (actor) is videotaped and receives feedback from an experienced physician. The biggest thing they always used to press us on - and still continue to impress upon the next generation of medical professionals - is that we should ask open ended questions. For example, questions like "how do you feel about your pregnancy" allow the patient the opportunity to give you much more information than "for how many days have you had a cough." As a resident, I quickly learned that asking open ended questions is absolutely the wrong way to go about things.
In my office, the patient gets asked exactly two open ended questions: 1) what brings you here? (asked at the very beginning of the visit) and 2) do you have any other concerns? (asked at the very end of the visit). If your goal for the visit is to address your patient's complaint and to do it efficiently, it doesn't benefit anyone to allow the patient to go off talking about random, irrelevant nonsense. Once you understand what their complaint is, you - the doctor - should have some ideas about what specific bits of information are important for you to know about. That's what medical school is supposed to teach you. You obtain those specific bits of information by making your questions as pointed and direct as possible. Your goal is not to identify every single problem the patient may possibly have. Your goal is to address the current problem that they're coming to your office with (hence, question #1). I believe it is then prudent to make sure that doctor and patient are both on the same page and that everyone understands everyone else (hence, question #2).
The students are lucky that they have me around to preempt some of the harm that might otherwise be done to their education.
I sometimes get myself into this rut where I find myself completely unmotivated to read. When there is such a vast ocean of knowledge out there, what can a few drops of knowledge possibly do to improve my ability to give good patient care? That's how we learn, though...drop by drop, taking a good sized gulp here or there. Put myself on a steady diet of 5-10 cc's of knowledge per day and, in two years, I just might be able to learn everything I need to know.
I continue to struggle with the concept behind the combined MD/PhD degree. For that matter, I continue to struggle with the concept of physicians doing research in the first place - even though it's considered pretty standard practice in academic medicine. If you want to keep your faculty position at Big University Hospital, you had better be writing grants and publishing. Why?
With the persistent, pervasive culture of publish, publish, publish pressing down upon me, I can't help but feel that I've been the victim of a 'bait and switch' somewhere along the line. I went to medical school specifically because I did not want to do research, write grants or publish. If I had wanted to do any of these things, I would have gone for a PhD rather than the MD which I very specifically remember checking on my med school application. The skills and knowledge required to do medicine versus the skills and knowledge required to do academics are not the same. Yet somehow, the medical community finds it natural that doctors should do research and, if you're already doing the research, hell, why not follow that to its logical conclusion - a PhD?
The way I see it, physicians and researchers are charged with very different tasks. Physicians are in the business of helping you. Physicians are interested in mastering as large body of knowledge as they can in the shortest amount of time possible and in applying that knowledge in such a way as to cure or help manage your medical condition. Researchers aren't interested in you. Researchers are interested in furthering scientific knowledge. People who do research and get PhD's spend huge quantities of time investigating an extremely narrow question, the answer to which is probably completely irrelevant to any medical condition that you have or ever will have. The whole point of being a physician is that we get to enjoy the fruits of this labor. Thousands of hours spent writing grants, controlling variables, running PCR reactions, taking x-rays and whatever else eventually does result in real and useful knowledge that we physicians have the pleasure of using in the course of patient care.
To me, a physician who studies, say chemotherapy drugs, is like an auto mechanic who studies structural engineering. And, I have nothing at all against structural engineers or cancer researchers. Quite the contrary. Only, it's not what I signed up for.
So that I can satisfy my technology fetish without having to support Apple, I am hotly anticipating the release of the palm pre. Just wanted to mention it in case any devoted readers need gift ideas :)
