The Cost-Effective Use of Leeches
and Other Musings of a Medical School Survivor
Jeff Drayer, M.D.
From: The Cost-Effective Use of Leeches and Other Musings of a Medical
Galen Press, Ltd., Tucson, AZ, 1998, pages 19-21..
night I was driving down Highway 15-501, thinking about studying
for my upcoming pathology exam, when a car about 300 yards ahead
of me suddenly flipped over. Everybody came to a stop. The police
quickly arrived on the scene and helped the driver out of her overturned
in the way any normal, non-medically trained person would be, I
sat and waited-until I heard a knock on my window.
you're a medical student, right?" Unsure who this person was,
I nodded dumbly. "Well, shouldn't you go help that girl or
something? There's no ambulance here. Just, like, check her out
or something?" Afraid to admit that my medical knowledge included
only a few isolated steps from the fatty acid cycle, I nodded dumbly
I thought: this could be my first chance to do something real, to
show society that one day 1 could become a successful doctor, despite
what any complex battery of tests and lengthy psychoanalysis said.
Fortunately, my bag from school was behind the seat. I grabbed my
ophthalmoscope, my reflex hammer, and both my 128-Hz and 512-Hz
tuning forks, and set out through the rows of cars to where the
girl was sitting.
waiting several minutes to bc invited to do an extended ENT exam,
I was finally noticed. "Can I help you?" the policeman
asked in the tone of voice of someone who knew that I could not
help. Several responses floated through my head, many of which did
not sound as lame as "Um, I'm a medical student, sir."
the policeman had dealt with first-year medical students before,
because my proclamation didn't seem to mean anything to him other
than that maybe, if I started to get out of line, he could shoot
me. So I continued.
a medical student," I repeated, letting the full weight of
my weeks of studying genetics sink in. "Can I do anything to
policeman did not look like he thought I could do anything to help.
But apparently having nothing better to do until the people who
did know how to help arrived, he gestured toward the girl in a manner
I could only assume meant "make sure you check her back for
fremitus too." I eagerly went to work.
hardest part was fighting against my Clinical Arts training, which
told me to ask the girl what had brought her here today. I didn't
know how to handle a patient whose problem did not need to be dragged
out of her by repeating the same question thirteen times. Unable
to call a "time out," however, I began my exam.
closed my eyes until the list of "things to do on a physical
exam" materialized in front of me. After examining her scalp
closely for moles or any other discoloration, I moved next to her
HEENT. Her sclerae were non-icteric, her Weber test localized better
to bone than to air, and her oral cavity showed no evidence of thrush.
I was just preparing to check whether her thyroid was midline when
"What the hell are you doing?" she asked. I had thought
it was pretty obvious. Perhaps she was having mental status changes.
'world' backwards," I suggested gently, but it was too late.
She had started to walk away. Fearing that I was losing control
of the situation, I produced my ophthalmoscope. A medical instrument,
I reasoned, could only enhance her respect for my medical acumen.
I put the ophthalmoscope to her eyes, I realized that first, I didn't
know what I could possibly see on her fundus that would alert me
to any problems caused by the accident, and second, I didn't really
know how to use the ophthalmoscope anyway. So I stood there, shining
and grunting, unable to see anything, but happy that the patient
was allowing me to look. Finally, satisfied that if she did indeed
have a retina, it was intact, I removed my face from hers (to her
obvious relief) and proceeded to stand there, desperately wondering
what to do next. Listen for murmurs? Do a gynecological exam? I
was explaining that she needed to lie on the ground for a moment
so that I could feel for hepatosplenomegaly when the whine of a
siren rescued us both.
One of the paramedics climbed out of tile ambulance, saw me with
my ophthalmoscope, and asked me for the "bullet."
what?" I cleverly responded, wondering if I should check for
lymph node enlargement.
"What's going on with her?" he asked, waiting for the
information necessary to care for her during her ride to the Emergency
"Oh. Sure. Um, car accident." .I was clearly in control
now. "Yeah. Car accident."
"How are her pupils? What kind of breathing pattern does she
have?" These questions seemed reasonable in that they sounded
medical. But I wasn't sure why they were relevant. Well, I was the
doctor-to-be here. I wasn't going to let some paramedic tell me
what was relevant.
"Oh, I didn't check those. But she's in regular rate and rhythm."
The paramedic called back into the ambulance. "Dan, I'm gonna
be a minute. Gotta do a quick exam." I was losing control of
the situation again.
I stood there quietly for the next five minutes as the paramedic
showed me how to do a physical exam on a person who has just been
in a car accident. As I suspected, no gynecological exam was necessary.
the patient was being loaded into the ambulance, I quietly stepped
away from the scene and walked back toward my car. As I did, people
started leaning out of their windows, thanking me and telling me
that what I had just done was great. I tried to explain that I didn't
actually do anything, that the closest I came to affecting the outcome
was nearly poking the girl's eye out with my ophthalmoscope. But,
strangely, no one would listen to me. I realized that they felt
secure just knowing that. there was a "doctor" there,
whether I did anything or not.
day I learned that there is more to being a doctor than accurate
diagnoses and successful treatments. People would expect things
of me and, whether those expectations were reasonable or not, it
would be my responsibility to try to live up to them. As I made
my way home, the whole thing seemed overwhelming. But then it dawned
on me that no matter how little I understood about medicine, lay
people would still listen to me, simply by virtue of my title. I
thought about that a little bit more. Suddenly, I smiled. Learning
all that pathology for my test didn't seem nearly as important anymore.
Galen Press, Ltd., Tucson, AZ