I came across the nastiest, gnarliest, most-awesome scalpel this week, when my attending called for the “Number 12 blade”. In surgery, I’ve only dealt with No. 10, 11, and 15 blades. I think the picture says it all:
I’ve always suspected that physicians have a narrower breadth of knowledge than the average professional, especially in non-medical issues. After all, college and medical school for them consisted of learning organic chemical processes and bizarre diseases.
My suspicion was confirmed recently during a friend’s wedding. A portion of the wedding lunch was dedicated to “wedding trivia”. It wasn’t the typical trivia about the bride and groom one would know from being their acquaintances, but rather hardcore minutiae a la trivial pursuit.
Topics included politics:
What is the term used to describe unintended civilian consequences resulting from covert operations from an aggressor government?
And science:
What is the name used to describe the first primitive bird considered to be descended from dinosaurs?
The teams were divided by dinner tables. My table consisted of internists, nephrologists, and other physicians. We placed near the bottom of the competitor list, behind the lawyer table (trivia nights at the pub must have given them an advantage) and all of the tables with PhD’s.
Conclusion: We spend too much time studying diseases that have no cures.
Note: The answers to the aforementioned questions are “blowback” and “Archeopteryx”, respectively.
We’ve learned in ophthalmic optics that a minus lens (concave) will minify images, while plus lenses do the opposite. I have been taught by several ophthalmologists to note the size of a patient’s eye through the glasses they’re wearing. If it looks big, then they’re hyperopic. Small = myopia. Easy, right?
Wrong.
In some cases, it is obvious that someone is myopic by the disproportionate size of the eye. To me, most of the cases are not obvious at all.
Years ago when I was still a medical student, Harry Knopf, one of the private attendings at WashU had told me to look at the temples, not the eyes. The refractive error can be estimated by looking at the temple border. Read more…
Obtaining a concise and accurate medical history is an art, and it often takes a lifetime to master. For the majority of us, we train for it daily in our clinical practice. On most occasions that we successfully arrive at a diagnosis through the history, the feeling is bliss. Rarely, however, it elicits anger.
Several weeks ago while I was on primary call, I was called by the emergency room (ER) attending physician about a woman who had left eye pain. The ER doc had dutifully checked the vision in her eye and found it to be 20/200 while the unaffected eye was 20/20. He added that she complained a sudden loss of vision in that eye as well.
I had just stepped into my apartment right before getting called, around 12:02am. Painful loss of vision is concerning by all means, and I rushed back to the ED while glancing through my Will’s Eye Manual for help.
My patient was a 40-yr old woman comfortably sitting in the exam chair. Her eyes were white, and on first glance, I could not determine which eye was in question. On brief exam, her vision in the left eye was indeed poor, although she did not have an afferent defect or a shallow anterior chamber. The fundus on the left eye was clearly severly myopic compared to that of the other eye. I suspected that she had poor vision in the left eye all along. Read more…