Short shorts on practicing medicine

Not a hair removal commercial.

When I’m a week overdue on a blog post, and I have exactly 20 minutes to write, but I don’t have one specific unifying theme, sometimes I start out by just jotting down the jumble of what’s been on my mind over the past two weeks. Hence, short short entries. These are organized around a recent series of clinical highs and lows I’ve had:

Screwing up: Lately I have dropped the ball on a few cases. Not enough to earn a lawsuit, or even enough to catch the attention of the patient, actually, but enough that I doubted my skills. I was disappointed with myself. I suspected that the specialist involved thought I was dumb. I wondered if I’m just too distracted. Too tired. Too dumb. I wondered if I’m good enough to do this demanding job, and if it will be better for mankind if I just quit and go to work in a bakery.

Being awesome: Then, I’ve had a few great clinical experiences lately where for whatever reason, I made a good call and/or gave spot-on advice, and the patient called or came back and was like: You are so great, thanks for helping me. And: You made a real difference for me. And: Thanks for showing me that you truly care. I basked in these kudos and tried to forget about screwing up.

Totally Sybil: Then recently I had a patient where both happened. Go figure.

Just do it: So I came to the general conclusion that while this is a demanding job, it is a job, and all you can do is the best you can do. If you do it right, and for long enough, you’re going to screw up, and you’re going to be awesome.

Don’t judge: We have a tendency in medicine to second- guess the other provider, to  say: Huh, I wonder why they did that. Maybe what the other provider did wasn’t in the guidelines or wasn’t evidence-based. Maybe it was a total screwup actually. Provided I’m not dealing with a situation of harm done, I try not to judge. I really, really try not to judge. Because sometimes the guidelines don’t apply; the evidence isn’t relevant; or we’re just having an off-day. And as long as we’re just doing the job to the best of our ability, we really don’t need to be judged. And neither does anyone else.

Don’t worry, Be happy: Realizing that both screwing up and being awesome are part of just doing this job, I’m working on not judging myself or others, not worrying about what others think of me, and being happy.

So when my colleagues wonder why I have an elderly fall-prone lady on nightly Restoril; why I treated an ear infection and a sinus infection with Azithromycin today; why I refer some back pain patients for epidural steroid injections; I say read this.

Likewise, I’ll be understanding when I have to refill your patient’s [fill in controlled substance here]; you prescribe something that makes me raise an eyebrow; or you recommend a treatment of questionable clinical benefit.

Despite the best efforts of those doing the research and creating the evidence, let’s face it, studies are flawed. Humans are flawed. Bodies don’t read textbooks.  Algorithms are dangerous. There is no right or wrong. Medicine is not black or white; it’s all shades of gray. There is great practice variation, and there always will be, because there is great human variation.

Let’s all relax and enjoy the work.