Monday, February 07, 2011

you've got to hand it to him

some students refused to listen to good practical advice. sometimes it hurt us all, but sometimes it was good for a laugh.

general surgeons have a reputation amongst doctors. they are viewed as crude, arrogant and even aggressive. this might be because they are often crude, arrogant and aggressive. but yet they are simple folk and can easily be pacified.

he was a private consultant. he was a typical surgeon but he was also a great teacher, if you could look past his rough mannerisms. he only came in one day a week and did a sort of a ward round. but in all reality it wasn't a ward round at all. he would ask us to show him some interesting patients and then he would teach us all about the condition of the first patient we showed him. he never addressed the patient. he never examined the patient. it was more coincidental that we would be standing next to the bed of a wide eyed patient while we listened to his tutorial. he taught us so much, including what a bedside manner should not be. he was also a great example of how not to present a patient to the professors.

"when you present a patient to doctor l," i would coach the students before the time, "do not go into all the detail!! he doesn't care. simply point at the patient and in a loud clear voice shout the diagnosis. then have a piece of paper and a pen ready. every word you hear after that is worth its weight in gold for your exams, so take notes." they all nodded, but i somehow knew they thought i was exaggerating.

the allotted time of the allotted day arrived and we all stood around waiting for the consultant. true to form he was exactly on time. he ignored the students as was his habit and only acknowledged me with an almost imperceptible nod of the head. i greeted him curtly and headed off in the direction of our first patient, which i had specifically chosen because i felt he had the condition the students most needed to brush up on.

we arrived at the patient and the consultant turned to the students. normal human interaction always seemed to be an effort for him. more looking at his own feet as anyone in particular he asked;

"right, whose patient is this?" the student stepped forward.

"mine!" he whimpered.

"well? what are you waiting for? present!" i had trained them well how to present to this consultant and yet i somehow knew what was going to happen.

"uhmm, the patient is a 25 year old black male..." the consultant lifted his head. his eyes were suddenly ablaze with what seemed like years of pent up frustration and anger. he cut the student short.

"do you think i am a blerrie idiot?? i can see the patient is male. i can see he is black. i can see he is about 25 years old! next thing you are going to tell me he is the third child in a broken home? i don't care about all of this. and if you even try to tell me he lives in a house with running water or no running water or whatever i think i'll kill you!! just tell me what is wrong with him!!!" i managed not to laugh, but as the student looked to me in supplication i confess a smile darted across my face. i had warned him. he shrugged his shoulders, pointed at the patient and in a clear voice shouted;

"alcoholic pancreatitis."

the consultant grumbled under his breath and extended his hand to the side, in the true fashion of a surgeon in theater. i was ready with the pen and slapped it sharply into his waiting hand. as if by magic, a sheet of paper appeared before the consultant. i remember thinking that they were at last listening to my practical advice.

thereafter the students (and patient if he was paying attention) got the best tutorial on alcoholic pancreatitis that they would ever be exposed to. i confess i didn't pay too much attention. i was otherwise occupied trying to suppress a laugh.


Jabulani said...


Beach Bum said...


DrBoo said...

Bongi, when do you think that the keen polite medical student with social skills morphs into an odd, driven nutcase of a consultant? I have begun to observe this in my colleagues. Registrar level, not too odd and then consultant level: very odd.

Funny story....I am struck by how similar the surgeons are across the world.

Vijay said...

most of my classmates (and i) would've loved to have someone like this consultant do "ward rounds" for us. can't count the times we had to bear with the seemingly unending detail of a "proper bedside case presentation" before we could get to the consultant's tutorial.
your consultant's outburst reminds me of an eminent prof who was the examiner in my mbbs days. will write that up as a post in a few days.

ps. nice to see you haven't gone out of the woods. yet.

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Greg P said...

It's a bit odd, but as I have matured in practice I am less tolerant of this kind of "teaching". Whenever we start at a diagnosis, it really puts the whole medical experience on its head. This is how I see people making horrendous mistakes, doing all the right things for the wrong diagnosis.

Of course, I'm speaking from the perspective of a nonsurgeon, yet I think there is still applicability. I have patients who become quite knowledgeable about their own condition, once they know what to google.