I’ve been out of touch.
My waking hours are
wasted spent “running to doctors,” as my grandmother of blessed memory would have put it.
So many doctors, so little time.
And the striking thing, the thing that literally renders me speechless, is that none of them ever touch me.
Not even with gloves on.
They “listen” to my heart and lungs through the three layers of clothes on my torso: camisole, tee, and blouse.
I’ll let you in on a trade secret: the stethoscope has to go on bare skin. Otherwise all you hear are three layers of cloth moving against each other: scritch, scritch, scritch.
They don’t look into my eyes, nose, or mouth, although volumes are written there.
Nor do they palpate my abdomen, which, if they did, would give them a surprise, since I have a couple of tender masses in there. In fact, my erstwhile gastroenterologist, who had it firmly in her mind that I had IBS before she examined me, mashed into my belly like a jackhammer, and while she watched me peel myself off the ceiling, she mumbled, “Hmmmm.” Yet she did not question her diagnosis. I fired her.
I got a shock the other day when I requested a copy of my latest MRI from a specialist who had only touched the affected part of my body one single time, out of the several times I’ve seen him. On that first visit he did pretend to listen to my heart and lungs. I had a sweater on that day in addition to the above mentioned layers, so his exam was extra special.
When I picked up my MRI report, the receptionist handed me a copy of the clinic notes from my most recent visit.
“Well developed, well nourished white female in no acute distress.
Pupils symmetrically reactive. Cranial nerves grossly intact. Trachea midline without deviation. No jugular venous distension. Heart: S1, S2 normal, no friction rub or gallop. Lungs clear to auscultation and percussion without wheeze or rales. Abdomen soft, non-tender, no masses…..”
In short, whether or not you know the jargon, here is an entire “normal physical exam,” none of which was ever done.
This is the gift of EMR, Electronic Medical Records. It provides a default “normal” physical exam, altered only if the provider inputs other findings. One would think that this amounts to falsifying medical records, wouldn’t one?
When I was a medical student, we (or at least I; I can’t speak for the other students) practiced this catechism of normal findings, writing it longhand over and over until I had it memorized in my sleep. That way we knew what was normal and what was not.
There were two differences, though: in my day we actually wrote things in paper charts. We had to write really fast, so our notes looked like this:
“WDWNWF in NAD C/O SOB x4H”
“Well developed, well nourished white female in no acute distress complains of shortness of breath for the past four hours.”
The other difference is that we actually laid hands on the patient. We had them undress and put on a gown so we could lay the stethoscope on their chest and close our eyes and listen for those subtleties and nuances of the music the heart makes. I remember silently cursing chest hair: scritch, scritch, scritch….
And if we didn’t examine something, we wrote: NE (not examined). But we were not allowed to not examine something, unless the patient objected, in which case we wrote: PUC (Patient Uncooperative)!
Although we are no longer allowed to describe physical findings in strings of acronyms (although we are apparently allowed to falsify that we actually examined the patient), there is one acronym I will never let go of, especially now that I am getting some practice being a patient. It is:
Which is supposed to stand for
“Within Normal Limits”
When I was a student we had an inside joke that WNL actually stood for
“We Never Looked”
Only nowadays, it’s no joke.
Oh yes. The Anorexic’s Nightmare.
I lost two inches because my spine in collapsing. Therefore, my BMI is now 25!!!! I’m suddenly overweight!
How did this happen?
It’s not fair! It was that rice I ate yesterday. That must have been it. Oh, wait! I ate a cookie! Gaaaaaa! And I’m not bulimic, so I can’t do a thing about it!