Word: knowingly
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...they get that way? Are they just smarter than everybody else? That always helps. But they're not just IQ-smart. It's a puzzle-solving facility. The most important quality in these doctors is that they just know so much. One of the doctors that I go to when I'm stumped has a screen saver on his computer that says, "Have you kept up with the literature today?" These are people who are constantly learning and adding to an already sizable knowledge base. And they have seen a lot. That's very important, because a disease...
...that note, you're somewhat critical of the limits placed on medical residents' workweeks. You say they don't really get enough time with patients. I don't know that I'm against the limitation on residents' work hours. I do think it's very likely that residents will make fewer mistakes if they're not tired. But the way residents now learn medicine was developed by Sir William Osler at the beginning of the 20th century. It was great back then. Doctors lived in the hospital; that's why they're called residents. Patients also resided in the hospital...
...themes in the book is the fact that too few doctors sit down and hear out the patient's story. Why is that? It's hard to listen to a story that's not told well. That's a terrible thing to say, but we all feel this. You know, when we're at the dinner table and Uncle Dave is telling a long, windy story, what you're really thinking is, "Where is this going? What is the bottom line?" That kind of impatience is not just limited to the dinner table; that's often how doctors feel. When...
...remember is that the diagnosis process is a collaboration between two experts: the doctor, who is an expert on the body and disease in general, and the patient, who is the expert on this body and this disease and these symptoms. There's no way for a doctor to know what the patient is feeling without asking...
...talk a lot about the death of the physical exam too. You attribute that, in part, to another very human response: doctors feeling awkward about touching another person in an intimate way. That's not something we hear about very often. I don't know that this has ever been studied in a systematic way, but it is, I think, very natural to feel uncomfortable touching people that you barely know. There are a lot of rules in our society about touching - who gets to touch, and where, and how. Even when you're in the crowd that's allowed...