the art of medicine

^ I used to think that phrase used to be a steaming pile of an eye-roller cliche. It would be in essays, medical school admission interviews, etc. and I grew sick of the phrase before I even got into medical school. Sure, we all used to say it was about talking to the patient, listening, being a decent human being, and all that jazz. Strangely enough, I think it's a bit more than that.

I used to think that if you knew your shit, you'd be set when it came to medicine. In a way, I couldn't give a good reason why the computers wouldn't eventually replace physicians (think: Watson from Jeopardy). I know I'm only had about a year and a half of solid clinical experience but I'm already seeing why it takes so @#*%ing long to get trained properly - it's so much more than knowing the facts.

Even at this stage, an orangutan that knows how to memorize things could tell you why a patient is vomiting after eating two-day old burgers sitting at room temperature, or why a toddler at this time of year  is developing a barking cough that is worse at night. Classic presentations of diseases or infections don't require much thinking, and even if it's of a relatively rare condition, it doesn't take long for it to be picked up.

The "art" I'm talking about is when there is a patient in the emergency department who is a 55 year old diabetic male, obese, a 30-pack year smoker, having chest pain and all their tests for a heart attack come back negative. Do you really let them go?

How about when that same patient comes in with pretty severe flank pain that's not resolving? Their kidney function and urine are fine. What next?

Each day, I'm learning it's not about the facts. Well, it sort of is. If you're a dumbass physician that doesn't really help... but that's not the point. I never realized that so much of medicine is about clinical gestalt. There were a couple of times early in my clerkship where I saw a patient, examined him or her, ran bloodwork which came back normal and reported that they should be OK. The physician would walk in and simply say, "Hmm, they just seem sick." And eventually we'd find out there was something seriously wrong with them.

Those were always humbling experiences. I used to think geniuses could get so far in life and move up whatever ladder they were a part of much faster than the rest of us. They'd be the ones who didn't have to practice or train as much, and would therefore be a step ahead.

Coupling what I read in Malcolm Gladwell's "The Tipping Point", and what I'm seeing every day in medicine, it's more about exposure, repetition and practice.

One way or another, most people appreciate or gain the science of medicine pretty easily. It's the art of medicine though, that remains elusive.

Steve Jobs tribute song (Mac sounds) by AzRmusic

Everyone has their opinion about Mr Jobs' death, but that's not the point of this post. Here is a very well done tribute song to Steve comprised of only his voice (from the infamous Stanford speech) and sounds from Macs.

Reminds me of that "Wear Sunscreen" song. Spoken word songs often give me the chills. This one was no exception.

Props.

can't keep up

maybe I'm just listening to too much music and procrastinating on #indecision2012 but there's too much fun stuff for me to keep up with...

The Asteroids Galaxy Tour - Major

Childish Gambino vs Chiddy Bang - Put It In Your Manners (DJ 12azy remix)

Oh Land - Bloodbuzz Ohio (The National cover)
The National - Bloodbuzz Ohio (Oh Land Cover) by Hypetrak

Keep in mind, the new Justice album Audio, Video, Disco drops October 25.

my shortlist for favourite album of 2011

Photo credit: The New Yorker

I will add more as I think of them and/or other albums get released...

Bon Iver - Bon Iver
Cults - Cults
Danger Mouse & Daniele Luppi - Rome
Explosions in the Sky - Take Care, Take Care
Feist - Metals

Foster the People - Houdini

Jay-Z and Kanye West - Watch the Throne

The Strokes - Angles

The Weeknd - House of Balloons

some call it a telephone booth

Taalbi Brothers - Freestyle (as seen on Breaking Bad)

Ridiculous guitarists... and they're teenagers.
This was the song that played after Walt said "We've got work to do."

Brilliant.

music feast

The number of albums I've been enjoying recently is kind of absurd. Just as I'm getting into one, another comes along and beckons my attention.

Take note, folks:

Future Islands - On the Water
M83 - Hurry Up, We're Dreaming
Feist - Metals
Alex Clare - The Lateness of the Hour


And some particular songs:

The Rapture - How Deep Is Your Love?
James Blake - A Case of You


Not... enough... time...