doctors

Doctors tend to enter the arenas of their profession's practice with a brisk good cheer that they have to then stop and try to mute a bit when the arena they're entering is a hospital's fifth floor, a psych ward, where brisk good cheer would amount to a kind of gloating. This is why doctors on psych wards so often wear a vaguely fake frown of puzzled concentration, if and when you see them in fifth-floor halls. And this is why a hospital M.D.--who's usually hale and pink-cheeked and poreless, and who almost always smells unusually clean and good--approaches any psych patient under this care with a professional manner somewhere between bland and deep, a distant but sincere concern that's divided evenly between the patient's subjective discomfort and the hard facts of the case.

The core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.

We want progress in medicine to be clear and unequivocal, but of course it rarely is. Every new treatment has gaping unknowns - for both patients and society - and it can be hard to decide what do do about them.

Where there were once several competing approaches to medicine, there is now only one that matters to most hospitals, insurers, and the vast majority of the public. One that has been shaped to a great degree by the successful development of potent cures that followed the discovery of sulfa drugs. Aspiring caregivers today are chosen as much (or more) for their scientific abilities, their talent for mastering these manifold technological and pharmaceutical advances as for their interpersonal skills. A century ago most physicians were careful, conservative observers who provided comfort to patients and their families. Today they act: They prescribe, they treat, they cure. They routinely perform what were once considered miracles. The result, in the view of some, has been a shift in the profession from caregiver to technician. The powerful new drugs changed how care was given as well as who gave it.

I have noticed that doctors who fail in the practice of medicine have a tendency to seek one another's company and aid in consultation.

Medicine__ a funny business. After all, dispensing chemicals is considered mainstream and diet and nutrition is considered alternative.

Western doctors are like poor plumbers. They treat a splashing tube by cleaning up the water. These plumbers are extremely apt at drying up the water, constantly inventing new, expensive, and refined methods of drying up water. Somebody should teach them how to close the tap.

Well, I've known over thirty men who've found out how to cure consumption. Why do people go on dying of it, Colly? Devilment I suppose!

Alcenith Crawford (a divorced ophthalmologist): "We women doctors have un-happy marriages because in our minds we are the superstars of our families. Having survived the hardship of medical school we expect to reap our rewards at home. We had to assert ourselves against all odds and when we finally graduate there are few shrinking violets amongst us. It takes a special man to be able to cope. Men like to feel important and be the undisputed head of the family. A man does not enjoy waiting for his wife while she performs life-saving operations. He expects her and their children to revolve around his needs, not the other way. But we have become accustomed to giving orders in hospitals and having them obeyed. Once home, it's difficult to adjust. Moreover, we often earn more than our husbands. It takes a generous and exceptional man to forgive all that.

Label-locked thinking can affect treatment. For instance, I heard a doctor say about a kid with gastrointestinal issues, __h, he has autism. That__ the problem___nd then he didn__ treat the GI problem.

Being a doctor, you are not supposed to give vent to any signs of revulsion on encountering the most noxious of odours or the most gruesome of sights.

No matter who you were in sixteenth-century Europe, you could be sure of two things: you would be lucky to reach fifty years of age, and you could expect a life of discomfort and pain. Old age tires the body by thirty-five, Erasmus lamented, but half the population did not live beyond the age of twenty. There were doctors and there was medicine, but there does not seem to have been a great deal of healing. Anyone who could afford to seek a doctor's aid did so eagerly, but the doctor was as likely to maim or kill as to cure. His potions were usually noxious and sometimes fatal__ut they could not have been as terrible and traumatic as the contemporary surgical methods. The surgeon and the Inquisitor differed only in their motivation: otherwise, their batteries of knives, saws, and tongs for slicing, piercing, burning, and amputating were barely distinguishable. Without any anesthetic other than strong liquor, an operation was as bad as the torments of hell.

I always feel that young doctors are only too anxious too experiment. After they've whipped out all our teeth, and administered quantities of very peculiar glands, and removed bits of our insides, they then confess that nothing can be done for us. I really prefer the old-fashioned remedy of big black bottles of medicine. After all, one can always pour those down the sink.

A so-called antimony war had been waged between French [Galenist] physicians and [alchemical, Paracelsian] iatrochemists since the beginning of the seventeenth century. What it lacked in bloodletting, this war made up for in bile.

Do what is right, and do it now.

Doctors are great--as long as you don't need them.

Every day," I said, "every day I go to work and I see my granddad. I see the drunks and the addicts, the people who have fallen right off the edge of the earth. I see people who have made every bad move anyone could make, made every major mistake there was to be made, and by the time I see them, they are paying for it, sometimes with their lives. That's why they came to the ER. "When you work in emergency medicine, you are seeing patients who are the least common denominator as far as human beings go; people who are heartbreakingly stupid and ditty and drunk and high and obnoxious--unbelievably obnoxious. These people have all flowed out of the darkest side of life. And when you are finished with them, that's mostly where they'll return. So each of you who is thinking you want to go into emergency medicine will have to ask yourself, 'Do I really want to do this?'" I tapped my chest. "I know the answer for myself--every day I work I'm taking care of someone who is just like my grandfather, someone just like my mother. But everyone in this room needs to ask himself or herself, 'Do I want to spend the rest of my life with addicts and idiots and drunks and psychotics? Is this what will make me happy?'" I peered at all of them over the top of the microphone. "Very few sane people answer yes.

I saved a man's life once," said Granny. "Special medicine, twice a day. Boiled water with a bit of berry juice in it. Told him I'd bought it from the dwarves. That's the biggest part of doct'rin, really. Most people'll get over most things if they put their minds to it, you just have to give them an interest.