Posts Tagged ‘Surgery’

This column was featured on the Association of American Medical Colleges’ blog “Wing of Zock” on May 7, 2012, and on KevinMD on May 10, 2012.

One morning recently, I found another physician standing morosely at one of the mobile computer terminals we refer to as “cows”—computers on wheels—that are everywhere now in our hospital. I asked what was the matter.  “Oh nothing, really,” she said.  “It’s just that I don’t feel I know the patients as well as I used to.”

I knew exactly what she meant.  Things are different now that we have the EMR—the electronic medical record.  After two months of use, we’ve learned to our sorrow that these records don’t tell us stories that make cognitive sense.  Instead they offer data in endless lists.

Before the written word, people told stories.  In every culture, around hearths and on journeys, they remembered and retold tales of great deeds, romance, and tragedy.  When we were medical students, we learned to present each case on rounds by telling the patient’s story.  The story had well-defined elements:  the current complaint, the background of genetics or misfortune that led up to the present, the investigation that might clinch the diagnosis, and the plan of action.

The best stories almost told themselves.  The business executive fresh from a transatlantic flight presented with shortness of breath; VQ scan revealed a pulmonary embolism.  The young woman with Marfan’s syndrome began exercising one morning and developed severe chest pain radiating to her back; the echo demonstrated aortic dissection.

Now, however, we have lists.

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There’s been a great divide between the medical and surgical specialties ever since I can remember.   Surgeons believe internists perseverate too much when decisions need to be made.  Internists consider themselves the true intellectuals of medicine.  I suppose anesthesiologists like me fall somewhere in the middle–we work in surgery, but have to take care of all the medical problems the patient brings to the OR table.  Does that make us the last true generalists?

Recently I brought my patient from the OR back to the medical ICU and gave report to the nurse; made sure that the vent settings were appropriate and that the arterial line waveform was crisp.  When the patient was stable and settled in, I headed over to the ICU desk to finish the paperwork.  The case had been a video-assisted lung decortication and evacuation of empyema, a two-hour procedure involving one-lung ventilation and considerable blood loss, in an elderly patient with a host of underlying medical problems.  Sitting next to me at the ICU desk was a young medicine resident.  He turned to me and asked, “What was the indication for putting in an art line?”

For a second, I thought he was kidding, so I didn’t immediately reply.  “No, really,” he said.  “Was there an event or what?”

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