In case you are wondering, the all-star Monday morning quarterback is me. I’m not good at Monday morning quarterbacking everything, but I do have my specialties: relationships, child-rearing, life decisions in general, finance, and other people’s patients. I’m awesome at any of those categories.
The more removed from the situation, the better I get. My own patients? They’re complicated little balls of nuance that may take me days to sort out. The med student’s patients? They’ve got a lot going on but more manageable for sure. My APP’s patients have their snags but I can untangle them without too much trouble. A different attending’s patients? Piece of cake. A different attending’s APP’s patients? Puh-leeze!
Similarly, it’s hard to know in the moment what the optimal thing to do is when the kid I’m babysitting wants to sleep and it’s not their designated nap time. But if you are narrating your sleep training woes to me I can tell you exactly where you’re going wrong. (Maybe let’s start with the idea that you need to train your baby to sleep.) Does it matter that I’ve never parented a child? No, all that experience would just muddy the waters.
Moral of the story, if you need help with your complicated patients, relationship questions, or parenting conundrums, look no further. I’ve got your back.
SDG
P.S. I hope it goes without saying that I do not actually believe any of the above is true… although admittedly I act like it sometimes.
When it is a relatively busy or steady shift at work, I’m happy to take on another task. Bring it on!
When it’s a slow day at work, by the end of the day I don’t want to do anything. Sitting on my hands for three hours and then having to take an admission? Agony!
On the other hand, if things are busy enough to be chaotic and the workload keeps piling up, I start getting overwhelmed. Fortunately, there are enough people scheduled each shift and the past load is such that I’m rarely in that position.
In terms of job satisfaction, slow day at work < hectic day at work < pleasantly busy day at work.
Similarly, if I have a relatively busy day, I am also likely to get my email cleared out as well as the few extra bonus tasks that have been on my to-do list. If it’s a slow day at work, at the end of the day I’ll realize I forgot to do a few required things. It’s curious.
As a patient, you do not want to be “interesting.” Being interesting typically means your symptoms are not coalescing into a standard diagnosis or for unknown reasons you are having an atypical response to things that normally work. It means as healthcare workers, we’re not sure what to do with you.
This is one of my most unfavorite things as a provider: not knowing what is going on with one of my patients. Frankly, it makes me grumpy. I’m not as nice to these patients, not because I don’t like them, but because I get frustrated. Getting to a diagnosis, even if it reveals that I was not being as smart of a clinician as I should have been earlier on, is a relief.
I am in the unfortunate situation of being an interesting patient myself. This afternoon I had an appointment with yet another specialist. I had a few goals for the visit, but mostly I was content that this would check another box off the long list of things I have or haven’t tried yet.
My appointment started twenty minutes late, and ran twenty minutes over, with a long wait in the middle. The specialists I saw do not know what is causing my problem, and they don’t know what is going to make it better.
And yet, I left the appointment feeling better about the trajectory of my care than I have for a long time. I felt hopeful, and grateful.
How? Why?
One observation is that the doctors, while acknowledging that they didn’t have a great idea of what is going on, didn’t toss me out like a hot potato. Instead, they expressed an interest in trying to figure it outwith me. They discussed the pros and cons of trying medications and therapies that, frankly, they have no idea will work or not, but should be safe to try. They encouraged me to try them, and are willing to do their part in facilitating what they can.
Another observation is that they utilized their connections on my behalf. The fellow and attending physician talked with a colleague who has more experience in the area that my ailment involves, and she joined us in the exam room to tell me her thoughts in person. She offered to discuss my case further with a colleague in a different specialty, as well as to reach out to someone she knows at Mayo Clinic for their opinion.
All of this felt like a giant relief. Up until now I’ve felt like I’ve been the one directing my care, asking to see this specialist then that one, suggesting one diagnosis and then another, asking about specific treatments, not knowing what I was doing. It feels like I’m now seeing people who, if they don’t know what they’re doing, know people who might – and they plan to follow up. It feels like they are going to keep trying things with me as long as they can come up with things to try.
To be clear, none of the other healthcare providers I’ve seen have done a bad job, but none of them seemed interested in taking ownership of the problem or being directive with next steps. And, it may just be that I finally found the specialty that I should have gone to in the first place, and the reason the providers are being so helpful is that they are truly the only ones who can help.
It’s one of those facts that gets brought up to illustrate how people don’t think rationally: way more than 50% of the population believes they are above average drivers. I think it is something like 90%. (Don’t quote me on that.)
Now, you could argue terms. What do we mean by average? Are we referring to the median, which in this scenario would be found by lining up all the drivers in order of worst to best driving ability and picking the person who is exactly in the middle? Or, are we referring to the mean, which would be found by somehow adding up the driving ability “scores” of all drivers, dividing it by the total number of drivers and designating everyone above that number as “above average”?
It matters, because when you use the median as your average, by definition half of the population will be below the median and half will be above it. That’s how the first paragraph builds its case. When you use the mean as your average, however, it would actually be possible for more than 50% of the population to be above average, if the below average drivers were just really bad. As an example, say there are ten students taking a test. Nine get 100% on the exam and one unlucky bloke slept through it and gets 0%. The mean grade would be 90% (add up all the scores, 100 + 100 + 100 + 100 + 100 + 100 + 100 + 100 + 100 + 0 = 900, and then divide the total number by the number of students, 900 / 9 = 90), so nine of the students would be “above average” and just one would be “below average” if by average we are referring to “mean.” The median would be 100% so ironically no one would be above average using that definition, although one student would be below average.
Using the median definition of average, I feel quite confident in saying I am a below average driver, and half of the people reading this (zero?) should feel comfortable admitting to the same. Anecdotally this makes sense to me. Considering the drivers in my family, I am definitely in the bottom half of skill level. To be clear, I don’t think I’m a bad driver, per se, although that could be argued. (The fender bender I got into this morning was not a confidence booster.) But wouldn’t you hope that more than 50% of our drivers are good ones?
On the other hand, if we use the mean definition of average, I’d be a little more uncertain about where I fall. There are some seriously bad drivers out there that would skew the mean downward, and I think it would be hard to be so outstanding at driving that you would meaningfully pull the mean upward. Perhaps I’d be able to squeak in “above average,” but if so more than half of all drivers would be with me.
In medical school, one of my small group leaders was Dr. Lydia Kang, who was (is!) an Internal Medicine physician who practiced outpatient medicine, and who was (is!) also a writer. When I went to the library to pick up a book on hold, I noticed one of her books on a display shelf and picked it up.
I’d already read one of her books in med school, after I found out she was a published author. I don’t remember the name of it, but it was a YA dystopian-science fiction novel about a girl with Ondine’s curse, a medical condition in which the sufferer does not have an intrinsic trigger to breathe. (In the book, she got around this by wearing a necklace that sent a stimulus to trigger breaths. Kind of like the Inspire devices for people with sleep apnea?) I don’t remember too much about it, which doesn’t necessarily reflect poorly on the writing because my memory is terrible now.
Anyhow, I just read my second Lydia Kang novel and it was… ok. Very competent! By the end I wanted to see how it ends even if it didn’t ring true all the time. I’m amazed by all the books she’s had published, it’s very impressive. And, she’s kind of like me! Well, not really. We’re both women, and we’re both physicians. I’ve taken care of a patient of hers before.
I’d love to do what she does, be a physician and a writer. A writer with a capital W, which I guess in my mind means published. Unfortunately, before that can happen, I actually have to, you know, write something. And then it has to be good enough to get published. And then it actually has to be accepted. I don’t think that will ever happen.
I guess I can be a physician and a writer, little w, right now.
My cat, Pemberly, is sitting in my lap. She is resting one of her paws on my right arm, but does not seem to mind the typing.
I have just paid $83.52 for the privilege of having this blog for the next three years. I don’t know what that actually gets me, as I’m pretty sure I’ve been able to start blogs for free before. They didn’t last, however, so maybe the money helps it last? Psychologically?
I spend too much of my time online. My husband asks what I’ve been doing, and I say, “Oh, you know, browsing the interwebs.” Going to NPR, or The Gospel Coalition, or AV Club, White Coat Investor, Humble Dollar, the every girl, Smitten Kitchen, anything I can think of. I like to think I have an addictive personality and at this point in my life the Internet is happy to supply the digital dopamine hits I crave. I end most long sessions with a mild headache, vaguely ashamed of myself and bewildered as to where my time has gone.
Well, the idea is that this blog could be a little piece of resistance. Instead of endlessly, and mostly mindlessly, consuming, I will mindfully create. I like writing. I like the idea of being a writer, even if I don’t think I qualify for the term right now.
