Many of my readers know me as Carson, the world-famous novelist and blog writer who must disguise himself in public, to avoid the paparazzi that follow me everywhere. A smaller sample of my readers believe that I am male underwear model, and these readers of course, are very special as long as they stay on their potent medications. However, only the most astute readers who read every word and chew on them like salt-water taffy from Stuckeys will understand that my main job is a physician.
I won’t divulge what kind of physician I am, or what specialties I practice, but it is something that I find rewarding in many ways, but also when I am working all night in the hospital, quite fatiguing. In fact, as I write this momentous piece of proud prose, I am sleep deprived from saving lives all night. So thankfully, spell check, if I can find it on the tabs, can save me from horrible spelling errors.
Recently, a certain administrator asked me what kind of exam room I needed, when I was in the office. He innocently asked me, “Do you actually examine your patients, Dr. Carson?” I looked at him, wondered if he was serious, but seems he was, and was not smiling. Then I realized, in this age of telemedicine, where you “examine” patients on video without touching them, the art of the physical examination was lost.
When I was a medical student, of course, that was only a short time ago, we were actually taught a year long course on the physical exam: How to examine the heart, lungs, abdomen, joints, muscles, neurologic function, etc. Now, when I see a medical student following me around, and I ask: “Do you know how to examine a patient and tell if they have a pleural effusion, vs. a pneumonia, without a Chest X Ray?”
Their response is simply a wide-eyed silence, staring at me as if I am an ancient hologram from the past, and when they finally catch their breath, they say, “No, we were never taught that in medical school. We will simply do an ultrasound test to determine this, or perhaps a CT scan.” Then, after I teach them this long-lost technique, they smile, walk away proudly with new knowledge that I hope they will use some day to help a patient. But these medical students are very intelligent, probably smarter than I am, but I am tougher, and at the same time, my brain is happily handcuffed sometimes, by a coruscating jumble of sparkling curiosity. That is the beauty of the art of medicine.
I will listen to a patient, ask them detailed questions about their symptom, then, try to piece it together with a combination of symptom patterns and examination. Yes, that means the famous writer/model actually touches a patient, listens to their hearts and lungs, pulses and appropriate exam techniques to narrow down the diagnosis, without ordering a million dollars of tests and referrals to other specialists to bail me out and find out answers.
Some patients come back to me and thank me for finding their atrial fibrillation (cardiac rhythm abnormality), even though it is not my specialty field, prompting further investigation that others did not take the time to detect, or, finding a specific neurologic diaphragmatic abnormality causing their breathlessness that was not detected for years without laying the patient on the exam table, then back upright, and percussing the diaphragm. Well, I could go on about this, but my point is the art of the physical exam, in the age of specific high tech diagnostic testing, is a lost art that I believe is still very useful.
So, the bottom line is I will keep doing what I am doing, because that is all I know how to do. I will not change, just to be popular or perhaps, quicker with patients to get them out of the office more efficiently. The old man Ollie has taught me to stay true to your values, fight for what you think is right, no matter what the cost, and then “endeavor to persevere.” (from Chief Dan George, The Outlaw Josey Wales).
Oh yes, and I pray to the Lord daily for the blessings he has given to me to use for others, if I can while still walking this earth.
© SRCarson Publications, 2024