Notes on a Physician's Life

All so easy when you’re on the inside.

Explaining tennis scoring to my not-into-sports wife as we watched the Wimbledon finals recently reinforced how much inside-baseball lingo there is to everyday life. We’re always at sea or on land in some aspect of our lives. 15-30-40: how silly can you get? Advantage-deuce-advantage (no, now it’s the other player’s advantage) etc – that’s how silly.

Business sections of newspapers have a penchant for photographs of traders in the pits of stock or mercantile exchanges. I’ve one on my desk as I write this – about 15 men and one woman on the trading floor of the NY mercantile exchange on July 9th last. Most have short dark-colored coats with badges of 4 numbers above 4 letters clipped to their left lapel. There’s a vaguely blue-collared look to the scene which I’m betting is deceiving – they’ve probably all got MBAs from Wharton or Harvard and are taking home mid six-figured incomes or more.

Certainly, all are intent on their work – on the phone, entering data on handhelds or slips. At least three have US flags over their left upper arm – they probably refuse to buy oil for more than $50/bl. The whole scene radiates tensity – one of the flag wearers has the tips of two fingers in his mouth. Hey, fella; is that my money you have at work there?

You ask yourself – at least I do – do they know what they are doing? Given the roiling financial markets of the past year why wouldn’t one?

The outsiders view of these insiders must parallel what lay people feel when crossing the portals of a hospital or clinic. Who are all these men and women clad in scrubs or white coats? Does the uniform reassure or rattle. Even if you can make out MD on a coat or badge is that resident, fellow or staff physician? Even if you know it’s a staff doctor does that really allow you feel sure they are experienced, competent and conscientious?

For years I had an office at the University of Michigan close to the nexus of the adult hospital and the principal outpatient facility. At certain times of the day (early morning and lunchtime most of all) it was a frenzied hubbub of activity. I knew many of these people and those I didn’t I could, in the main, characterize their role in the whole apparatus. But even that didn’t quiet the wonder in me about how this whole apparatus worked together. It seemed ripe for a Rube Goldberg drawing.

Yet, it worked, and not just in the main, it worked quite well, thank you, a testament to who or what, I’m not quite sure. Perhaps, most of all, to the intrinsic good nature of mankind.

For the outsider though, it’s not intrinsically reassuring. Signage, however much improved over times past, still needs work at most healthcare centers. But it’s the orally produced signs where the most work is required – the language of the healthcare cognoscente in his or her individual work with a patient is where the difficulty is most likely to emerge. Recollection of how easily any of us can feel at sea when out of our own cultural and professional milieu might help us be more thoughtful and patient when we’re the knowing one and they’re the at sea patient.