Monday 28 April 2014

Ad Infinitum!

Ad infinitum..
The problem with being a generalist is that there are always people who know more than you in any area. Surely, I used to think, if one restricted one's practice to a very limited area, such as ophthalmology, it would be possible to know virtually all that the state of the art contained.
A number of years ago, I was at a medical meeting, I think somewhere in New York State, and I was having lunch with one of the speakers, who was an eye specialist from New York. I didn't know his specialty and asked him,conversationally,
"And what do you do?"
"I'm a retinologist," he said, handing me his business card.
It read:
Retina, Lens, Vitreous. Inc. (vitreous is the jelly inside the eye).
Dr. A - Lens. Dr.B-Retina. Dr.C-Vitreous.
Being a dumb GP from Saskatchewan I asked,"Who refers to you? When I need to refer to an ophthalmologist I need a good generalist who is likely to be able to deal with whatever I send him."
He smiled, tolerantly,"My referrals come mostly from general ophthalmologists,who can't define the problem or have mismanaged the case or performed unsuccessful surgery and want me to bail them out".

When I was a schoolboy, we used this appropriate jingle :
Big fleas have little fleas, that on their legs do bite 'em,
And little fleas have lesser fleas,
So on to ad infinitum!

Friday 25 April 2014

"The Secret Language of Doctors!"

My letter to the Editor of the National Post, re a book which I feel misrepresents the behaviour of most of the physicians, nurses, residents and medical students.
Most, and I have known many, over half a lifetime, have been very respectful of patients, although there are exceptions to every rule and the phenomenon he describes may be more common among Dr. Goldman's friends:

The article in Friday's Post describing Dr. Goldman's book "The Secret Language of Doctors -Cracking the Code of Hospital Slang" perpetuates great inaccuracies. The book itself does a great disservice to patients, doctors and nurses. I have practiced Family Medicine for over fifty years and have spent much of the last twenty-five of them as a Professor of Family Medicine and have been in constant close contact with medical students and residents in more than one province, during that period. I have only heard of one of the list of disrespectful terms that Goldman sensationalizes. Indeed, I have talked to nurses from Mt. Sinai Hospital who inform me they have heard only one or two of the term and very rarely.
There will always be a few disrespectful individuals in any profession, but Goldman certainly leaves the impression that these terms are in daily use, when he knows they are not. In so doing, he does great damage to patients, physicians and to patient - physician relationships. I suppose that doesn't matter as long as he gets a book out of it.
Stanley G Smith, Professor Emeritus, Dept of Family Medicine, University of Western Ontario.

Monday 21 April 2014

Don't go to work in Your Pyjamas

                 Interesting article in one of our National Newspapers recently by a Nurse of some thirty years experience commending a trend apparently coming out of the Maritimes suggesting that nurses should look like nurses (i.e. be appropriately uniformed and clearly distinguishable). Patients prefer to easily recognize the professionals who are treating them and not ask the cleaning staff for medical advice. In the hospital environment white uniforms clearly show up dirt and stains which may be potential sources of infection. Nurses should not look as though they are coming to work in their pyjamas.
When I was a Department Chair many years ago, I had a departmental dress code in place so that many of the crunchy granola types of the era had to look clean, reasonably groomed and look as though they could just possibly be doctors, some day. Patient expectations demanded no less.
I'm told I could never get away with that now!
Ah well, just consider me a grumpy old man!!