Long ago a professor of Cardiology from Iran came to train with us in the echolab. The embargo through the 80's left them with little technology (though lots of textbooks). Assigned to me, we took in the elderly and portly Italian lady. He first did his history and physical and told me what we were going to find (he did not have the requisition). And sure enough he was correct - good LV fxn, moderate MS, moderate posteriorly directed MR, mild AS with mild AR, mild-moderate TR with moderately elevated PA pressures - all from his stethoscope, his hands, and his eyes. History and physical...
It is so rare that I can comment with substance on this site - being a psychiatrist - but perhaps this is pertinent. I worked a significant portion of my career in prisons. I have seen men and women in such varying circumstances, yet one thing seemed to draw them together in my mind, and it came from a seminal work by Irvin D. Yalom, MD, Professor Emeritus of Stanford University, entitled, oddly enough, "The Principles and Practices of Group Psychotherapy." In one chapter, he sets forth what he terms the "healing factors" of psychotherapy generally, and number one at the top of that list is, "The Installation of Hope," and the discussion of which floored me. This principle changed my entire practice & my entire way of approaching patients. And from that day forward, I vowed that no forensic patient - no matter how much their act or behaviour struck me or impacted me personally - would leave the office provided for me in that bleak correctional institution without receiving that message of hope; the message that change was possible, that help was available, that your life could literally be different, and that I was available to asst you if you chose to do so. Over the years, some did, in fact, choose to make a change, while many did not.
And I will share one story before moving on: I was in line at a large discount store making some small purchase, and when I got to the register, with the restrooms directly across from me, a young man was attempting to move an industrial bucket with several mops from one of the restrooms, banging everything, causing a lot of commotion, trying not to curse, drawing a lost of attention. When he finally got out, he turned around, and I immediately recognized a former forensic patient I knew had recently paroled. Undoubtedly in the context he didn't recognize me, but I was so happy to see he was employed I was beside myself as I walked to my car. Occasionally, I am a better physician for that one change in thinking.
While protocols are helpful, the goal of controlling doctors leads to more treating and less healing
Long ago a professor of Cardiology from Iran came to train with us in the echolab. The embargo through the 80's left them with little technology (though lots of textbooks). Assigned to me, we took in the elderly and portly Italian lady. He first did his history and physical and told me what we were going to find (he did not have the requisition). And sure enough he was correct - good LV fxn, moderate MS, moderate posteriorly directed MR, mild AS with mild AR, mild-moderate TR with moderately elevated PA pressures - all from his stethoscope, his hands, and his eyes. History and physical...
It is so rare that I can comment with substance on this site - being a psychiatrist - but perhaps this is pertinent. I worked a significant portion of my career in prisons. I have seen men and women in such varying circumstances, yet one thing seemed to draw them together in my mind, and it came from a seminal work by Irvin D. Yalom, MD, Professor Emeritus of Stanford University, entitled, oddly enough, "The Principles and Practices of Group Psychotherapy." In one chapter, he sets forth what he terms the "healing factors" of psychotherapy generally, and number one at the top of that list is, "The Installation of Hope," and the discussion of which floored me. This principle changed my entire practice & my entire way of approaching patients. And from that day forward, I vowed that no forensic patient - no matter how much their act or behaviour struck me or impacted me personally - would leave the office provided for me in that bleak correctional institution without receiving that message of hope; the message that change was possible, that help was available, that your life could literally be different, and that I was available to asst you if you chose to do so. Over the years, some did, in fact, choose to make a change, while many did not.
And I will share one story before moving on: I was in line at a large discount store making some small purchase, and when I got to the register, with the restrooms directly across from me, a young man was attempting to move an industrial bucket with several mops from one of the restrooms, banging everything, causing a lot of commotion, trying not to curse, drawing a lost of attention. When he finally got out, he turned around, and I immediately recognized a former forensic patient I knew had recently paroled. Undoubtedly in the context he didn't recognize me, but I was so happy to see he was employed I was beside myself as I walked to my car. Occasionally, I am a better physician for that one change in thinking.
Thanks so much. It seems like I need to give that a read.