Wednesday, January 25, 2012

I Know Nothing

One of the things I like about medicine is it definitely keeps you humble (well, it ought to). Just when you think you have some vague sense about something, another GIANT hole in your knowledge is revealed (for you to fall into, in front of a patient).

Dr. J asked me to talk to a newly diagnosed patient about how to manage her diabetes.

Er...can I tell her instead about how to landmark for the femoral pulse? Or the 10 most common reasons for pancreatitis? Or, about how long troponins will be raised after a heart attack, instead?

So...Mrs. Glucose, lets, about diet. Sorry, not a diet, per se...but what you normally eat in a day...

Oh, normally I get up and have a cup of tea and a fag, then I'll eat something for lunch, usually...and then there's dinner, usually with spuds.

Riiiiight. OK. Maybe you can tell me a bit more about what you normally eat for lunch and dinner then...

You know, a roll, meat and veg.

[Dr. J reenters room]

So, ABB, did you make much headway with the discussion on lifestyle changes, nutrition and managing sugar levels??

Yeah, um....not so much. 


I know nothing about how to motivate people, how to explain nutrition, how to advise major lifestyle changes, how to counsel for smoking cessation, what the normal step-wise approach is to managing a newly diagnosed diabetic. In a nutshell, I am rubbish. Unless you're having a heart attack in front of me. Then I am slightly less rubbish.



Grumpy, M.D. said...

I still know nothing. I just know slightly less nothing than I did back then.

Just Me said...

Handouts - creat handouts. People never remember anything anyways. Also gives you a way to walk through things with your patient. But I've been in practice for years and still walk into the hole of knowledge- thank goodness, otherwise I'd get bored.

Sarah said...

Annnnnnnd---that's why you're in training. You aren't supposed to be able to pull all the medical sophistication of an attending out of your ass. At least, I hope that's not what people do. It was a substantially more laborious process for me, and I am still working at it as an attending.

Elizabeth Shouldice said...

Oh my dear ABB, this is one of the hardest things, but you know LOTS about it. One of the most challenging things in medicine. Use your allied health peeps and learn from them. (ie. if you need to know how to use a community based glucometer, as your friendly Shoppers pharmacist!).

Gelfling said...

And THAT is why most folks get referred to a diabetes education specialist when they are newly diagnosed! Learning how to ask the right questions and focus on the most important points, plus using language a non-medical person can understand, takes a lifetime of practice!

thethingspatientssay said...

You'll be shuffling that responsibility off to the aforementioned diabetic educator once you're out. Takes too much time and there's not enough in the way of reimbursement to make it worth your while.