The physical exam is an underestimated tool. Back in New York I would challenge my medical students after assessing a patient; what information had they gathered from the 24 seconds we had just spent with a patient? Inevitably, they couldn't come up with much; and I'd be able to explain how I had systematically assessed the entire patient all while chit-chatting about their upcoming surgery. But, I didn't carry a stethoscope, and Lord knows my otoscope hasn't left it's bag since I moved home from Mexico. My physical exam skills are, at best, a far cry from what was painstakingly learned down in Mexico. And that was okay in New York, even in Indiana, the physical exam is supplemented with an abundance of ancillary information from lab work to imaging. Essentially a diagnosis declares itself, and I use my physical exam to verify what the other information is suggesting.
The process of taking out and dusting off some of these physical exam skills is easier said than done. I knew what a crutch ancillary information provides, but to experience my limp without the crutch is very humbling. My 24 second assessment just isn't enough when I don't have daily lab values, or advanced imaging to lean against.
The Swiss Cheese effect is often utilized to discuss never-events in medicine. I'll include a picture, because it is much easier to understand in picture form.
Each layer in the swiss cheese is not perfect; therefore the more layers of swiss cheese, the more safe guards in place that a never-event will occur.
Swiss cheese in Togo is about one layer thick with a giant hole right through the middle. Standing in that hole and trying to catch and/or stop these never-events... well, I fail. Often.
The Lord is faithful, and reminds me of his promises daily. Reminds me of his control of life, but it doesn't make the losses any easier. Especially when I feel I could have somehow picked up on small nuances of change in physical exam, and therefore reacted sooner, or better. It's all a process, a learning process, but also a forgiving process. I'm working on one, perhaps struggling a bit more with the other.
Break of dawn as I left the hospital for the third time the other night.
"From the rising of the sun unto the going down of the same the Lord's name is to be praised." Psalm 113:3
Much Love.
“The greater the artist, the greater the doubt. Perfect confidence is granted to the less talented as a consolation prize."
…… Robert Hughes
The above quote came to mind a few times thinking about this post. There is only one artist, or physician, who approaches pottery or patient able to create, or cure, with perfection.
I will be praying you can grasp the "forgiving process" a bit more each day. Keep your chin up, love you.
Prayers are with you. Be gentle with yourself and remember the Swiss cheese effect still happens in the US, even with all the safeguards. You're doing the best you can with what you have. Lots of love.
Prayers for you as you adjust to medicine without all the familiar safeguards! Thankful you feel Gods mercies each day!