Thursday, April 21, 2011

Wanna Be a Doctor? How Cool is This?

Recently, I was examining a teenage girl whom I suspected of having Mono. In order to determine whether she had swollen glands, an enlarged liver or a dangerously enlarged spleen, I checked her abdomen.  I started tapping on her abdomen by placing my index and middle fingers of my left hand on her upper tummy and then tapped the two fingers gently with my right index finger.   The sound to a physician is unmistakable.  There is the hollow sound of the underlying intestines (filled with gas and drum-like) and there is the dullness or hard sound of the underlying solid liver. 

"What the heck are you doing?" she asked.  So I explained to her about this ancient technique called "percussion" and how without an xray, MRI or a CT scan (terms she was familiar with), I could estimate the size of  her organs and whether they were normal. 

"That is SO COOL!"   she exclaimed.  I was thrilled that this simple method could intrigue my young patient so I asked the question I always do when someone shows the least bit of curiosity about medicine: "Did you ever think of being a doctor?"

I told her about Abraham Verghese of Cutting for Stone fame and his wonderful list of simple skills that every physician should have.  Called the Stanford 25 , it is a compilation of physical diagnosis maneuvers performed at the patient's bedside with little more than a stethoscope, the four senses (we don't do taste anymore!) and a trained mind.  I was happy to see that the examination of the liver is the fourth technique on the list.  I first discovered Verghese's mission when I was in Haiti with no technology other than what I brought in my backpack.

The deprivation of working in Haiti isn't necessary to appreciate the value of these fundamental skills.   I am reminded every day of how much I enjoy practicing the basics and trying to solve the body's mysteries.  Not to mention turning on a student every now and again to the field of medicine.

image from Google images

7 comments:

  1. That really is cool - love to see basic medical techniques used well even in these very technical days. My dad was a doctor in PNG and treated people who were encountering white culture for the first time. His was a government position and he was supposed to be training the natives to help out at the hospital; a difficult task as their ideas of numeracy were so vastly different to our own! He has a funny story about how he thought he was teaching them to measure blood pressure and they were merely mimicking everything he did ... because they had no concept of numbers like "eighty four" or "seventy six" :)

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  2. Thanks for your comment. We can all learn from our cultural faux-pas whether medical, linguistic or sartorial.

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  3. this was my dream, my father was a doctor too, but he never wanted that I were a doctor, cause he says you have a lot of responsibility and many lives in your hands...

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  4. You don't have to be a doctor either, to be a medical professional. You could be perfectly happy as a medical billing specialist, for example, if you can't make it as a doctor.

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  5. I think my dentist Woollahra teeth filling started this way, and ended up a licensed dentist.

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  6. You should have thought her about the 4 steps to examining a patient. Inspection, Palpation Percussion and auscultation so that she will be more impressed. buy viagra

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  7. She seems fascinated about what you did. If I were her I would feel the same.

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