Do you ever feel like there aren't enough hours in the day? Or
how you got to the end of the day when it all flew by so fast? This
is what it feels like, when I'm busy. The days when I have 3
patients in the clinic (which is the most I've had so far) seem to
fly. There's barely enough time to get all of the paperwork done:
chief complaint, history of present illness... I find that on those
days, it feels like maybe 2-3 hours have passed, and then the shift
is over. How did that happen?
There are a million things that I want to go over with patients.
I take LONG histories; really long ones. I ask questions that
nobody ever asks (and often have to spend time explaining why I'm
asking them). This piece of information is important for that. I
need to know that so I can tailor it for them so I can help them
get better. It never fails. Of course, it's hard to go through all
of that, feel like I haven't left something out, and still get
Of course, one of the great downsides to asking all of those
questions is having to write down all of those notes. I write books
in my patient files. In a way, I feel sorry for my clinician having
to read all of these notes, and then on the other hand, I like
A chalkboard used by Nobel Peace Prize winner Linus
Clinic is cooking along. I have a few regular patients, and new
patients coming in here and there. My favorites will always be
those with complex problems, especially functional ones. These
patients need so much more time. Their appointments seem to go by
even faster than the more simple ones. What changes can we make?
Are there things that can be changed? What are the parameters that
we're working with? So many questions, so little time to ask and
Research is ongoing. I'm trying to squeeze in articles when I
can, or when I have any free time. Right now I'm reading one about
xenobiotics and autoimmune disorders. Sometimes I think my head
will explode, or at least want to bang it into the wall when I
can't remember what a specific interleukin does (even though I've
looked it up 9,000 times already). Really I just love it, and can
see why people go into research full time. Although, the
application of it is exciting in and of itself. If only I could
know "everything." Of course we'd find new things to learn and
explore, and learn that things that we knew before were completely
and totally wrong, and have to learn them all over again -
differently. I guess that's why we're scientists.
The photo above is from one of Linus Pauling's chalkboards. If
you're not familiar with Linus Pauling, he was the only person to
be awarded two unshared Nobel Peace Prizes. He was a brilliant
chemist/biochemist and activist, and completely changed the way we
think about human biochemistry. He was a huge advocate of
"orthomolecular medicine" (which we now know as functional
medicine), vitamin therapies, and supplementation. I'm absolutely
fascinated by his work, and have had one of his books sitting on my
bookshelf for many months. If only I had the time to read it.
OK, Everybody, go learn something really cool (and then tell me
about it so I can learn too). But in case you're burnt out and
don't want to learn anything, enjoy some Moose yoga. I wish I could
stretch some of my patients out like that!
Have a Great Week, Everybody!!!!
The trimester is coming to a close, and I can honestly say it's
flown by. We're all scrambling to meet deadlines in the clinic:
this many of this, that many of that. It hardly seems that about 12
weeks ago we were terrified we'd be horrible at this. Truth be
told, I didn't think anything about deadlines and numbers and
paperwork (OK, well I did think about paperwork a little bit).
That's probably why I'm scrambling now.
The last couple of weeks have been discussions about who is
transitioning to the other clinic, and some talks about where we'll
end up. Half of our crew is moving to the other clinic. It's
unlikely that I'll see them very often. Perhaps we'll have seminars
or training sessions of some sort, or get together outside of
school (although we don't do that now). But in a few weeks, there
will be another big transition for all of us. Some of us have been
together, nearly every day, for about 3 years. This will be
something really new.
Newness. It reminds me of my theory about Maslow's Hierarchy
from last week. Incidentally, I've been working some more on that,
but I'll spare you all the details. I had the pleasure to discuss
it with two of my fellow interns today, the concept of new ideas.
We were talking about my theory, and about other theories -- things
in medicine and science that seem to have been left behind. We were
discussing the idea that there are no new ideas.
Image by http://mladavid.deviantart.com
Mark Twain said:
"There is no such thing as a new
idea. It is impossible. We simply take a lot of old ideas and put
them into a sort of mental kaleidoscope. We give them a turn and
they make new and curious combinations. We keep on turning and
making new combinations indefinitely, but they are the same old
pieces of colored glass that have been in use through all the
I grew up not far from good ol' Mark Twain's stomping grounds,
but between you and me, his writing always made me crazy. No matter
how much I tried, I couldn't understand the dialect he wrote. I'm
not sure that I agree with Mark; it seems we're discovering new
things all the time. From god particles to medicines, we strive and
learn how to change, adapt, and understand the world around us.
If the last 12 weeks in the clinic have taught me anything, it's
that we have no standard approach to treating anything. We have to
be willing to come up with new ideas, or at the very least, new
applications for old ideas. For every patient that comes in, even
if they have the "same" diagnosis, what works for each one of them
is likely to be something completely different.
I'm fairly certain that our discussion today came to the
conclusion that there has to be something new. There has to be a
pursuit of Science that crosses boundaries into new territories,
that bypasses the need for a randomized controlled trial of
everything, and simply embraces discovery for the sake of
discovery, and implementation for the benefit of the whole. Perhaps
we're all idealists. I see no problem with that. Being idealistic
just promotes my love of the field and my hope for making a
Neil deGrasse Tyson, in his series "Cosmos" said:
"To make this journey, we'll
need imagination, but imagination alone is not enough because the
reality of nature is far more wondrous than anything we can
OK, Neil. I'll take that one to heart. The greatest theories
come from crazy idealists.
I wish you all many great new discoveries. May your kaleidoscope
always look just a little bit different.
You're not behind the desk, you're sitting in the chair next to
it. Waiting. Waiting, for what seems like FOREVER for them to come
look at you, examine you, swab, cut, bleed, sample, whatever you.
They're taking forever. You feel wretched. Everything aches,
stings, hurts. You're tired from staying up all night worrying,
hurting, stressing. You only want to know what's going on and you
feel like you're simply the only person on the face of the planet,
and no one is able or willing to help you.
I'm trying to explain what it feels like to be sick -- to be
frustrated with the status of the medical profession and confused
and angry and scared. I'm trying to explain what it feels like, no
matter how melodramatic it may be, to feel like someone else has
control over your health, what's wrong, and if and when you'll get
better. There's a feeling of being completely helpless that comes
with being sick -- when there's pain, when there's no observable
pattern or relatively easy diagnosis, or when it just seems to drag
on forever. It's a feeling that no one seems to understand -- like
being held hostage by something or someone and being powerless to
do anything about it. And it doesn't go away -- that feeling --
until there's some grasp over the problem, like some answer, lab
result, diagnosis, something, ANYTHING that seems to give some
control over the situation.
If you, as a person, have never felt this way, count yourself
lucky. But many others can't say that. Our patients likely can't
say that. They come to us hoping for understanding and compassion,
and the willingness and ability to find out what's wrong. I only
hope that they find it.
It's hard to be the patient when you're used to being the
physician. It's also hard to be a physician when you've never been
a patient. William Hurt, in a 1991 movie called "The Doctor"
illustrated just this. Having been an important, influential
physician, he finds himself with cancer -- and realizes just how
horrible of a physician (no matter how skilled) he (and some of his
colleagues) could be.
People come to us in their worst conditions. They're not always
in a good mood. They're not always understanding of our limitations
as physicians (or students). They come to us seeking help and
advice -- and of course, our expertise. Finding answers is what
we're supposed to do. It's what our training is based in and what
we've been working towards for our academic/professional
But all of that training only provides a fraction of what our
patients need from us. They need our compassion and understanding.
This isn't taught in school. It comes from within, and
unfortunately, it comes from experience.
(Image source: hopeinhealingblog.wordpress.com)
For some of us, it's been sickness that has made us this way --
or abuse, or poverty, or just LIFE. For others, it's those things
that are in the process of making them that way.
Be kind to each other this week, Everybody. Have a great
Nearly two and a half years, countless exams, memorization of
facts and figures, pathologies, prescription drugs, and maneuvers
that scare you to death -- and you think you might actually know
"something" (but not everything). And then the first patient walks
through the door and you realize nothing you could've possibly done
thus far could have prepared you for what you're about to
experience. Welcome to being a student physician.
Throughout my various collegiate undertakings, I've felt
ignorant. There was never much of a point to thinking I knew
everything or even all that much because I was constantly reminded
that whatever bits and pieces I've pulled together meant only a
drop in the bucket toward what's out there. I hate feeling
ignorant. Maybe that's why I'm constantly reading and researching
-- because I know that I don't know anything.
Ricky in Radiology Positioning class
(Special thanks to Dave Aiello and Ricky King for this
Dr. Harrison, our clinician, brought up an excellent point last
week (he has LOTS of amazing pearls of wisdom). He said that the
stuff that we learn the best is the stuff that we're faced with. If
there's a condition that we, a family member or friend, or a
patient has, we WANT to learn about it. And so we learn those
things the best. But when something is sitting right in front of
you, there's this overwhelming need to know it -- right now.
Sometimes that learning curve can be pretty frustrating.
Questions get asked. Tell me about your family. How are you
feeling? What's going on in your life right now? Can you describe
this or that sensation? As the physician, you're supposed to know,
not only what it is they're talking about, but also how to put all
of it together to make sense of what is in front of you. It's a
complex task. Then you have to take the person in front of you, and
figure out how to make them better, take away the pain they're
having, help them cope with what's going on in their life, and help
them re-enter their space of wellness. And of course, you hope that
they're working with you on this. This takes skills they don't
teach in school. We can take all of the interviewing skills
sessions, basic and clinical sciences, and psychology classes and
still not be able to put all of these "issues" into the complex
Being that sits in front of us. So, as I sit here wearing my white
coat, I can honestly tell you that nothing I've done over the last
two and a half years prepared me for my first patient. Not a thing.
Not even remotely. Of all the things I've learned, even over my
whole life, listening seems to be the most beneficial.
One of my biggest fears when starting clinic, besides being
worried I wouldn't know what to do, is that I would be stuck with
pure musculoskeletal cases. I know, this is chiropractic and
musculoskeletal would theoretically be a big part of most chiro's
practice, but I wanted the hard cases. And I'm getting them. From
complex vascular issues to hormone imbalances, I've had to do
research in the first week on topics that we didn't learn in any of
our classes. Before any physical exams, before any orthopedic
testing, just doing the history, I'm learning so much. I love
learning this way. Get a topic, find out as much as you can, and
then apply it.
Pick up a copy of Harrison's Internal Medicine, and
also a copy of the Textbook of Natural Medicine, and
Textbook of Functional Medicine. All three of these will
serve you very well. Even though these three are great resources,
there are some things that still require digging. I love a
challenge. Good thing I'm in the right field.
Have a great week everybody!
• After the DC Degree
• Botanical Medicine
• 1 Year at National
• Marketing Project
• First Week in Student Clinic
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