The Freeze : A Physician ’ s Perspective
20 LOUISVILLE MEDICINE
The month of January this year was miserable due to the extreme cold weather ; my medical office was shut down for two days and I spent quite some time listening to The Weather Channel . The word “ freeze ” was mentioned more than 30 times in one hour . The gloomy days coupled with total loss of sunshine added to depression and boredom . I wanted to snap out of the gloom and finally resorted to a technique that has been consistently helpful to me in the past : the Quiz Ten . Let me provide some background for this personal fantasy .
The primary goal of a clinician is to make an accurate diagnosis promptly . The clinical evaluation often parallels a crime scene investigation : recognizing and utilizing all clues ( symptoms , signs , images and the lab data ) to zero in and catch the criminal , viz ., the underlying disease . I had the good fortune to observe a brilliant professor ( decades before the arrival of computers ) who was endowed with the uncanny ability to make “ instant diagnosis ” just by the clinical history and keen observation of the patient . It appeared that the professor had mastered a unique protocol for efficient
by VASUDEVA IYER , MD
stacking of exhaustive medical knowledge and instant retrieval of data relevant to a given patient . We all revered the professor , and I could recall only rare instances where he was proven wrong ; situations that evoked strong feeling of schadenfreude in our envious minds ( it is fascinating that fMRI is pointing to different areas of the brain that are involved in envy ( anterior cingulate cortex ) vs . schadenfreude ( ventral striatum ). 1 Emulating the professor was not easy , as the precise neural mechanism of his clinical prowess was quite obscure . Nevertheless , I did persist with the effort and resorted to a more mundane technique : try to retrieve information instantly such that I could describe 10 relevant facts about any given medical problem ( symptom / sign / pathology / treatment etc .) within a span of five minutes : the Quiz Ten . For example , if the symptom is tremor , one must instantly retrieve information on 10 known facts about tremor : causes , features , tests , treatment and so on . I also developed a system of self-criticism and admonishment when my performance was unsatisfactory using an annoying rating system : the Holmes-Colombo-Clouseau scale ( genius-average-moron ). That ’ s Sherlock Holmes ( created by Conan Doyle ), Lieutenant Columbo ( an old TV series ) and Inspector Jacques Clouseau ( The Pink Panther movies ).