DOCTORS’ LOUNGE
great ER docs in Louisville; we have a long
and honorable tradition of an intense, exacting, superbly professional Emergency Medicine residency here. A lot of them I know
only from their voices on the phone. I have
to go look them up in the GLMS mugbook
to see them (or at least what they looked like
in 1992). They are masters of the short, pithy
presentation and recommendation of care.
They call quickly when the patient is unstable and slowly when they are thoroughly
completing the workup, to see if truly the
person must stay, or can safely go. Certain
voices make me smile and relax right away;
new voices cause a tingle of anxiety. They
know we rely on their judgment and that we
immensely, absolutely and totally appreciate
the hell out of them.
I think of my stream of consciousness
when I (like the other PGY-3 Medicine residents of many Grady eras) was the ranking
doctor at night, in the MEC, alone, no faculty in sight. We had fellows of all stripes
we could call; we could call our brethren;
we relied immeasurably on the nurses. It
was a live-fire exercise in fear, requiring
immediate recognition, rapid action, and
repeat. Our brains went, “Check, check,
check. Right, right, right. Oops better call
GI; check, check, check, check, admit, admit, admit, admit, admit, home, home,
home. Oops, get Cardiology down here
now!” The satisfaction came from know-
ing, knowing, knowing, did the right thing,
next, next, next. What haunted us was Not
Knowing.
Thankfully, my ER docs who call me do
know. They should also know, we are all
eternally grateful.
I leave you with how they talk on the
phone here: one answers, “Pronto.”
One ends, on a descending scale of loudness, “CIAO, CIAo, Ciao, Ciao, ciao.”
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Barret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
SURGICAL CREDENTIALING IN ENGLAND: M.B.B.S., F.R.C.S.; NOT M.D.
Gordon Tobin, MD
D
ear Editor:
I
wish
to correct
errors in the published title of my
remembrance of
Robert Acland (Louisville Medicine 2016;
63(12):14). First, he
was born in 1941, not 1921. Also, his medical degree was not M.D., but M.B.B.S.,
F.R.C.S., which are the usual credentials of
English-trained surgeons. This variation
from American post-nominal degrees confuses many, but much about medical history
is revealed. Whereas medical school graduation in North America brings a doctorate
of medicine (M.D.), the English equivalent
is the paired degrees of bachelor of medicine and bachelor of surgery (Medicinae
Baccalaureus, Baccalaureus Chirurgiae,
abbreviated M.B.B.S., or variations such
as M.B.Ch.B.). This dual degree does allow
the English graduate to be called “doctor”
as a medical practitioner, although not a
recipient of a doctoral degree. Historically,
the earliest North American colonial med-
ical schools (Universities of Pennsylvania,
Toronto, Maryland, Harvard and Columbia)
followed this practice in the 18th century,
but switched to the Scottish tradition of
awarding M.D.s around the end of the colonial era. Throughout the former British
Commonwealth, practices vary widely in
post-nominal designation of medical school
graduates.
The designation F.R.C.S. (Fellow of the
Royal College of Surgeons) designates qualification to practice as a senior surgeon for
those so trained and examined, such as Bob
Acland. This dates back to the individual
Royal Colleges of Surgeons in Edinburgh
(chartered 1505), Ireland (chartered 1784),
and London (chartered 1800). America’s
F.A.C.S. (Fellows of the American College
of Surgeons) carries forth this tradition. As
current President of the American College
of Surgeons, Louisville’s J. David Richardson, M.D., F.A