PHYSICIAN-IN-TRAINING/
MEDICAL STUDENT CATEGORY
WINNER
2015 RICHARD SPEAR, MD,
MEMORIAL ESSAY CONTEST
THE MACHINE IN ALL OF US
I
Joseph Bales, MD
love having technology at my fingertips.
From my very first shift in the ER I quickly
realized my computer and smart phone had
replaced my textbooks from medical school
and were much easier to lug around. I could
now look up the medication, dosage, interaction, and side effects of any treatment, all while
maintaining eye contact with my patients.
The upsides to using technology are many. Using the latest app or
medical website has decreased errors, improved patient safety and
kept myself and countless other doctors up to date with the current
guidelines. My attendings encourage their use, knowing that taking
the extra time to look something up means we are learning more
and guessing less. Even in the midst of a code I have seen doctors
whip out their ACLS smart phone app... Two minutes CPR, Epi
1mg, pulse check, V-fib, shock, two minutes CPR, give Amio 300mg,
pulse check... lather, rinse, repeat. Especially during those first few
codes - a scary situation with someone’s life in your hands - there
is now a step-by-step guide available at our fingertips.
In medical school I studied the stages of grief and read chapters
in a book about how to tell someone their loved one had died. I
recently referenced this chapter online just minutes before having
to tell a family about the fate of their murdered son. It read... be
forward, be direct, be confident, be humble, and expect all sorts of
reactions. So when that father threw his chair through the ceiling
when I told him about his son, I was surprised but half expected
such a response. With the help of the latest tech I could handle life
threatening situations and grief reactions, without even breaking a
sweat. This is when I recognized I was at risk of becoming a robot.
22
LOUISVILLE MEDICINE
But as my years of residency have passed, I have realized that
despite my reliance on technology, a machine could never perform
my job. I still use my computer or smart phone on a daily basis, but
the practice of medicine is so much more than an app. Patients are
people and people (and their situations) are unique in every way
we can imagine.
Last week I saw over 150 patients. Every diagnosis was determined by a series of questions, vital signs, history taking, physical
findings, specific lab testing and imaging until it all added up to a
diagnosis that I could treat and disposition appropriately. I’m sure
I could insert all this data into one of my apps and it could handle
each situation, but sometimes it’s just not so simple...
Case #1: 6-year-old male comes in for fever, sore throat, vomiting
for the past three days. ‘Burns like fire’ to swallow. Mild headache,
and maybe some abdominal pain per dad. Fever 103oF, looked terrible on exam, but I’ve seen this a thousand times, strep positive,
gave him some ibuprofen and a day off school, amoxicillin as long
as he’s not allergic and he’ll be fine. Until I pushed on his abdomen
and he flinched just a bit more than I’d expect. I decide to give the
ibuprofen some time to work and came back and reassessed. Thirty
minutes passed and fevers gone and patient said he’s feeling better,
but still just seemed a bit too tender right around his belly button.
‘Shoot,’ I think, ‘this disposition is already thirty minutes longer than
it should have been.’ I trudged back to my attending feeling like a
failure to get an ‘easy dispo’ home. The computer would have had
him home long ago. I’m glad I strayed from the algorithm - formal
ultrasound confirmed the ruptured appendix.
Case #2: 58-year-old gentleman history of high blood pressure
and cholesterol (noncompliant), comes in with chest pain, crush-