Sometimes I surprise myself.

Back in medical school, I remember trying to listen to the heart of a newborn.  Damn thing was beating so fast, I kept thinking, “How the hell can anyone hear a heart murmur?”  A pediatrician told us it just takes practice.  One has to listen to hundreds of normal hearts in order to be able to recognize one when it’s NOT normal.


Well, that’s actually true for a lot of things in medicine.  Last year, I felt a very abnormal prostate.  It was so obvious to me at the time, that I wasn’t that surprised.  I just realized that it was NOT normal.   Two months ago, I did a routine breast exam on a woman and felt something very, very concerning, completely unbeknownst to the patient, sadly.

Then, yesterday, I saw a two-week old infant for a weight check.  I put the stethoscope on his chest and heard something.  “Whoosh-whoosh-whoosh….”  Hmm … I concentrated really hard, asked mom to stop talking (she was telling me all about his bowel movements) and listened again.  Was this his breath sounds I was hearing?  Definitely not – watching his chest rise and fall, this was clearly a cardiac sound.  Oh. My. G..   This wasn’t there a week ago!

I drilled mom with questions:

“Does he ever sweat with feeds?”

“Does he turn blue in the lips when feeding?”

“Does he breathe faster than you think is normal?”

She answered no to all the questions.  I watched him. He looked happy, content, breathing normally.  The child seemed perfectly fine.  Still, I was concerned enough that I referred him to our local pediatrician who confirmed the presence of the murmur, “It wasn’t really that loud,” she later told me.  Well, it was LOUD to me!!  lol!  In any event, the infant is in good hands and will be diagnosed soon (with, hopefully, nothing more serious than a small VSD that will close on its own).

Despite the pediatrician telling me it wasn’t all that loud, I still had to pat myself on the back.  I heard it.

There are times in my career (and personal life) that I wonder if I am doing the right thing, if I have done all I could have, if I should have done things differently.   I am far from perfect.  I am a flawed individual but I am deeply conscious of it.   I am very good at admitting my mistakes and “bad calls”, yet I rarely give myself due credit for a job well done.

Not anymore.

What they don’t teach you in medical school.

There’s a few things that medical schools fail to teach medical students.  Some things you just learn by experience, ie. from your own life or from just seeing the same things over and over and over again.  And there are things that you are either good at or not.

1. How to counsel a first-time mother who’s completely stressed out that her 1 month old infant sleeps all day and is up all night.

2. How to show said first-time mother how to get her infant to latch.  Breastfeeding is fucking hard!

3. How not to keep your patients waiting.

4. How to run a business.  A business?  Say again?

5. How to hire a good secretary.

6. How to manage an efficient office.

It’s the last three that are really what this post is about.  I share an office with two other physicians.  Actually, I joined their practice 5 years ago.  Since then, we’ve hired one additional secretary, who is, for all intents and purposes, totally useless.  Let’s call her Rosemary.  Okay, so that’s not really fair.  Rosemary knows how to scan documents and doing the e-filing.  But that’s about it.  She isn’t very good with the phones, can only do one task at a time, and when trying to talk to her it’s like talking to a brick wall.  So, you might ask, why did we hire her?  For the life of me, I can honestly say, I have no fucking idea.  I think, back then, we were looking for someone to do filing, work on referrals and hoped that the person would grow into the job and eventually take over as primary receptionist as our current gem is nearing retirement age and would like to start cutting back her hours.  But this is not the person we got.  So, the hunt began  and we put an ad in the local papers, did a few interviews and met a lovely woman who we decided to hire.  How the hard work starts.  We need to cut back Rosemary’s hours so that our new secretary takes over the roles of answering phones, working on referrals etc.  The kicker?  We haven’t exactly told Rosemary that this is happening.  Oh, she knows that the new girl was hired, but she doesn’t really know we are cutting her hours.  Ugh! Where was this class in medical school?  Seriously!

I got into medicine to be a DOCTOR, not a boss, not a manager, not a small business owner.  But this is exactly what I’ve become and I can honestly say, it’s the part I hate most.  I’m not good at it.  I’d like to be, but it’s just not in my nature.