Louisville Medicine Volume 67, Issue 9 - Page 29

DOCTORS' LOUNGE SPEAK YOUR MIND If you would like to respond to an article in this issue, please submit an article or letter to the editor. Contributions may be sent to editor@glms.org. The GLMS Editorial Board reserves the right to choose what will be published. Please note that the views expressed in Doctors’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine. I GOT A PULSE YET? AUTHOR Mary Barry, MD ’ve been teaching bedside medicine since 1987, to a host of medical and nurse prac- titioner students, and to interns in medi- cine or in a transitional year. For the first time ever this past August, I was shocked speechless. It was my new Family Nurse Practitioner student’s first day. I had her watch and listen only for the first two patients of the day, so she could relax a bit, and see how it was done. My wonderful patients were old hands at helping me to teach. They watched and listened, too, as I explained how I was feeling the pulse, taking the blood pressure, why I was checking the airway anatomy, why noting the biceps reflex relaxation, etc. With the third patient, I sat there typing and said encouragingly, “Go ahead and take her pulse.” She responded, “What do you mean?” The patient and I exchanged looks. I said, “Just - take her pulse?” I could tell she was mystified. She seemed shaken, too, because I was unable to mask my look of dismay. She simply did not know. She looked up instinctively for a bedside monitor instead. So I taught her. Some weeks later, when we were better acquaint- ed, she explained why she thought she had suffered other struggles with the physical exam. She had learned it, she said, online. Yes—she had watched some lady on the computer show how to examine someone. Instead of touching a person, she had touched a keyboard. It was totally different, she said, when she could have me check her doing the same things as I. She could not get over how different. She was amazed. I was simply stunned, and then angry. We now have seven- million-year-old pre-humans and at least four-million-year-old Homosapien remains that we have found preserved in the earth. For the past multi-million years, we have learned how to care for each other from a person standing next to us, a person who knows what we do not. This person is able to place our hands, correct our technique, guide our stethoscopes and explain our findings. This person teaches us to think on our feet—quickly and accurately. From this teacher we learn first to note, then to name, what we see and hear and feel. This person is not a hologram, not an actor, not an app and not a simulation. This person is the real thing. Dr. Lou Martin and Dr. Louis Heuser taught me how to feel a belly. Dr. Gurbi Sohi taught me to how to check for pulsus para- doxus, in an old lady with a malignant pericardial effusion. Dr. J. David Richardson had me feel for femoral pulses on a veteran, and when I could only find one side, had me palpate the abdominal aortic aneurysm. Dr. Hiram C. Polk taught us the breast exam. Dr. Ken Walker taught us to never, ever neglect the pelvic or rectal exam. Dr. Joe Hardison taught me to check for a fluid wave in the cirrhotic. Dr. John T. Galambos taught me four places to inspect for jaundice. Dr. Laman Gray Jr. taught me the instant recognition of cardiac tamponade. Dr. Corey Slovis taught me how to prove someone is faking unconsciousness. Dr. Robert Powell taught me to find a pleural effusion. Dr. Yong K. Liu taught me petechiae, and what leukemia bruising looks like. Dr. Ed Dorney taught me peri- cardial rubs. Dr. Wayne Shugoll taught me to listen for atrial flutter. Dr. Walter Badenhausen taught me about pseudogout. Dr. Henry Sadlo taught me to recognize endocarditis. Dr. Willis Hurst taught us neck veins (he tried to teach us vectors, but not all of us learned them). Dr. Julio Melo taught me signs of sepsis in the rheumatoid arthritic – just one of the innumerable things he taught all of us. Dr. Rafael Jurado taught me about Kaposi’s Sarcoma in its myriad forms. I could go on for days but should spare you. (continued on page 28) FEBRUARY 2020 27