The White Coat Underground has been around in one incarnation or another since May 2007, and in that time I've experimented with my writing style and content. Over time, I've moved from angry quackbuster to angry quackbuster who prefers to write more eclectically. This year, Medgadget's annual medical blog award nominees include WCU. Of course I'm excited for myself, but I'm more excited that over the years I've been able to engage a diverse group of readers in serious discussions about medicine, my passion and my avocation.
As my readers may know, I recently moved to a new practice, one that is extremely busy. It sits at the confluence of several major avenues and highways, making it easily accessible from the city and a variety of suburbs. It has a good reputation, earned the hard way by my new partners. One of the physicians recently moved out of Michigan, and the staff and his patients have been warm and welcoming.
Building a relationship between a doctor and a patient is not simple. Your abdominal pain may be run-of-the-mill to me, but for you, it is unique, painful, and frightening, and somehow I must win your trust in a few simple minutes. I have to get you to tell me your most intimate secrets, and you must allow me to examine you in ways that seem somewhat less than natural. In that short time, while meeting your eye and listening, I'm watching---watching how you sit, how your brow furrows in subtle discomfort when you move a certain way, the color of your skin, what you do with your hands.
Sometimes, when I listen to the heart, I close my eyes. I need to see the chest rise and fall and watch the effects of the heartbeat on the chest wall, but after that, I close my eyes, try to shut out everything else, and listen to the heart sounds, for the character of the first and second sound, for any extra sounds, for murmurs. I lose myself in the beauty of the physiology of the heart, of how much can be gleaned from just listening.
If I spend a couple of minutes listening patients usually ask, "everything OK with the heart, Doc?"
"It's been beating for 70-odd years, and it's never stopped. How amazing is that? I don't see any reason it should stop now."
The science of medicine, the mystery of the doctor-patient relationship, none of it is ever boring, and though I may write less frequently, I hope we can continue this conversation for a long time.