{"id":34875,"date":"2013-04-02T17:16:48","date_gmt":"2013-04-02T21:16:48","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=34875"},"modified":"2013-04-02T22:31:31","modified_gmt":"2013-04-03T02:31:31","slug":"seen-the-movie","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/04\/02\/seen-the-movie\/","title":{"rendered":"seen the movie…"},"content":{"rendered":"\n

A funny thing happened on the way to growing up. While I was in medical school, we got a new chairman of Internal Medicine at the University of Tennessee. He was a big guy, both in persona and in medical reputation – not the kind of person you’d expect at a State Medical School in Memphis on the banks of the Mississippi. But he was a determined Streptococcus researcher, and the Mississippi Delta and eastern Arkansas were at the epicenter of the streptococcal related diseases in the world – Acute Glomerulonephritis and Rheumatic Fever – so Memphis is where he wanted to be. He never said it outright, but we had a contract, Dr. Stollerman and those of us he trained. We cultured the throats and skin lesions of every patient that came near the hospital to feed his huge frozen locker full of the bugs he loved to type. In return, he showed us what a doctor was. <\/p>\n

He was at every Morning Report, every Grand Rounds, made rounds weekly on every ward [and he knew if we were there too]. If we got a case at night that we didn’t understand and didn’t call him, he raised so much hell that we never made that mistake again. I recall a late night when he was along side as we were heading down the long ward aisle to restrain a Lupus patient psychotic on steroids, throwing the contents of her bed pan at us and the other patients. On another night, I admitted a case of Beri-beri, a case of Scurvy, and a woman with Tetanus. I felt like the best diagnostician in North America. After a brief acknowledgement in the morning, he marched our entire residency class from case to case showing us all the things about each case that we would never have imagined anyone knew. None of us could ever figure out how he knew so much.<\/p>\n

But that wasn’t the most important part. When he made rounds on the wards, we lined up around the bed, but he talked to and looked at the patient. If he turned to question one of us, he’d explain why to the patient. And when he came back the next week, he’d stop by and speak to the ones he’d seen before. While we picked the patients to present, frequently he’d scan the ward and move us to the bedside of the patient he thought needed seeing the most. He taught us that the most important thing about being a doctor was knowing when you don’t know something. And if one of us asked a question he couldn’t answer, the next time you saw him, he’d tell you what he found out.<\/p>\n

I sometimes find myself wondering what Dr. Stollerman might think about all the tangles in psychiatry I write about today. I think he would say something like, "What does that have to do with taking care of patients? What’s wrong with those people?" But I bet that sometime later that week, he’d be talking to the Chairmen of Psychiatry he knew around the country trying to figure it out. I’m pretty sure he’d really like both Ben Goldacre and David Healy, but caution them both not to get too stuck in a rut of knowing.<\/p>\n

That brings me to why I thought about him today. I was thinking about clinical judgement. In some of the  comments, there’s a somewhat predictable dichotomy. Clinical judgement as medical imperialism, shooting from the hip versis clinical judgement as the highest order patient focused wisdom. I know that I way overstated that – the right of literary device. But I thought of a story from the dawn of time. One of the things Dr. Stollerman was vigilant about was overuse of medication – antibiotics, opiates, tranquillizers<\/em>, and particularly steroids. Steroids are both miracle and curse drugs. You can do wonderful things or really blow it. One summer’s evening, we were at a resident picnic. My wife was great with child [I mean greeaat]. She had weeded our back yard in her nesting fervor and had a rip roaring case of poison ivy. She was miserable. I hadn’t put her on steroids, having taken on the Chief’s conservative approach to their use. He called me aside, smiled and said, "You’ve learned well," and then he handed me a prescription for the steroids that melted her poison ivy overnight [after that, my wife loved the guy almost as much as I did]. For Dr. Stollerman, there were no rules – only cases. He didn’t preach the art of medicine, he practiced it.<\/p>\n

In an odd way, he probably had a greater influence on the psychiatrist I became than any of my teachers in psychiatry. And no, I haven’t read his book. I doubt I will. I’ve already seen the movie…<\/div>\n","protected":false},"excerpt":{"rendered":"

A funny thing happened on the way to growing up. While I was in medical school, we got a new chairman of Internal Medicine at the University of Tennessee. He was a big guy, both in persona and in medical reputation – not the kind of person you’d expect at a State Medical School in […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-34875","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34875","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=34875"}],"version-history":[{"count":11,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34875\/revisions"}],"predecessor-version":[{"id":34886,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34875\/revisions\/34886"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=34875"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=34875"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=34875"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}