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The earnestness of being important

As I toil1 on the back wards with the frail, the confused, the languishing (but enough about the doctors I work with; on with the article) I gain insight into a few things about medicine and the world. Insight, in those who actually recognize same, doesn't change our own behavior because we save our best insights for those around us. Behavioral advice is appreciated by no one more than the giver. Still, some insights can be, well, insightful.

First: People are either filled with fear and loathing of doctors and avoid them (us) like the plague, or the reverse.

"I like doctors well enough," said the confident happy-faced 93-year-old lady, "I just don't like going to them." Compare her with her 30-year-old granddaughter, a stressed-out mother of three. "I don't know what's happening, I'm so rushed. The minivan is a savior; what with soccer, and music lessons, and school and friends. And getting the kids back and forth to the doctor every other day is such a production."

People who live to be old rarely visit physicians. Therefore, avoidance of doctors should, by some wild and illogical digression, prevent death and disease. Modern medicine and its local representative (you) have much to offer individuals and society; but beware, much wants more. The wise physician offers neither too little nor too much to the weary and the wary.

Second: People respect individual doctors but mistrust the motives and statements of medical associations, or the reverse.

"Whatever they pay you, Doc, it's not enough," blusters the 38-year-old self-made man. "But that medical association wanting an across-the-board raise is ridiculous. I can't run whining to the government for cash just because I want it. Why should those money-gouging goons be able to belly up the trough whenever they please?" Fine enough, but if this "You're OK but your profession stinks" diatribe pounces on the day all your OMA insurance policies come due, you might (at your peril and with later regret) offer up the party line.

The reverse situation is often stimulated by the many pamphlets and clinical practice guidelines put out by various and sundry medical associations. "I see by this booklet from the Department of Health," remarks the very careful, retired 60-year-old who is the only person in the province, besides the secretary that typed it, to have actually read the document, "that tetanus immunizations should be done every 10 years. You gave me my last one after only nine years. What gives?"

The detailed, uninsured, discussion about provincial policies ("Experts must have decided on them for a reason") versus the day-to-day practice of medicine (and how mundane issues like weather, holidays and family meld with official policy), takes longer than does you usual lunch, which you missed because you're now running late.

Third: Doctors take themselves too seriously, or the reverse.

When I was an intern things were different! The only time we had beepers was when we were on call for the in-house cardiac arrest team. At grand rounds, because nobody else had one, when the thing went off everything stopped. Serious stuff when your beeper starts its staccato. Important people had beepers then, now we all do. So: if we all have beepers, and if all our beepers vibrate, and if we are all important doctors, why then do some beepers actually beep. Our importance, apparently, is directly proportional to how often and how completely we interrupt and intrude on those around us.

On the other hand2 we sometimes forget how important is the doctor with the pleasant manner: the touch, the smile, the kind word soothing a troubled day. We sometimes forget that the way we speak and act will be remembered by our patients more often than what we said or did. Our importance can be felt more in the gaze or our patients than in the wail of our electronic shackles.

1. "toil" in context: make rounds, talk with patients, write prescriptions, meet families, bill MCP.

2. She had a wart.