I spend Monday to Friday each week immersed in the production of 3D medical animation and medical illustrations for legal cases, but most weekends, you’ll find me seeing patients at a local Urgent Care clinic attached to a major area hospital. As much as I love the hours spent at my workstation translating a physiological process or a surgical procedure into images, the actual practice of medicine still holds a unique fascination for me after more than 30 years at it. It seems that this fascination derives from 2 aspects of clinical practice; the first is simply the intellectual challenge in considering the patient’s history and physical examination, and attempting to arrive at the correct diagnosis and treatment. Well, very often, not so simple as it turns out, but of course, therein lies the challenge. Just like fingerprints and snowflakes, no two humans are the same, and no disease process manifests itself quite the same way in two different people. To give a relatively straightforward example, acute appendicitis usually presents with short-term abdominal pain, but beyond that, there can be incredible variability in the presentation. Some folks start with pain around the umbilicus, which lasts for several hours to a day or two before localizing to McBurney’s point in the right lower quadrant; some develop rapid onset of pain that starts at McBurney’s from the get go; some have an elevated white count of 15,000, and others have no elevation at all; some are doubled-over from the pain, while others complaining of three days of pain appear completely unphased. The process of sorting through these nuances is not something that can be learned from a book. It can only be engendered by repeated encounters with the disease over a period of years – in other words, through experience.
But there is a second aspect to medical practice that keeps me coming back to clinic year after year. Simply put, it is the opportunity to communicate effectively with patients. “Communicate effectively” sounds a bit dry, doesn’t it? But for me, it’s the essence of the ”Art of Medicine”. And effective communication can be particularly difiicult in the Urgent Care setting. Unlike regular clinical practice in Primary Care, where you have a chance over the course of months or years to really get to know, and form a relationship with a patient, in Urgent Care, seeing patients who are complete strangers is the norm. In a very brief period of time (usually 10-20 minutes), the Urgent Care clinician must gain the trust of a person they’ve never met; in most cases, a person who is not feeling or functioning anywhere near their best; make that person feel that they are really being listened to while eliciting the critical details of the history and performing an appropriate physical examination, and then arrive at a diagnosis and treatment plan, and explain all of this to the patient in a way that is comprehensible. To carry all of this out properly requires a finely honed skill – a skill well beyond the basic ability to correctly diagnose and treat. It tests one’s powers of concentration – to be able to shift your focus exclusively to the patient in front of you (while in the middle of juggling the workups of half a dozen other patients); to appear calm and unhurried when you may be anything but; to maintain eye contact and body language that says “I care about you”; and to be empathetic, kind and gentle, when your reserves of these quantities may be perilously low.
The culmination of the visit, the “payoff” if you will, that, for me, yields the greatest enjoyment, is the “explanation”. It represents the summing up of all that has gone before, and it can make or break the visit from the patient satisfaction point of view. It requires taking all you’ve learned in that few minutes you’ve spent speaking with and examining the patient, integrating that with your accumulated fund of medical knowledge and experience, and finally, synthesizing all of that into a concise, cogent, non-medicalese description that the patient can understand and accept. It’s not always easy to do, in fact, seldom, but when you get it right, you can feel the positive energy flowing to you from a patient who not only understands and trusts in what you are saying, but who also appreciates the fact that you’ve put your best effort forth in caring for and about them. I liken the good feeling I derive from such encounters to the way a comedian must feel when a joke hits the mark with an audience, or when a musician elicits a roar from the crowd with a particular song. This love of “good vibrations” may sound a bit narcissistic, but we all want positive feedback from our fellow beings, and if that provides the inspiration to work towards constructive goals in our lives, or others lives, I fail to see the downside.
Indeed, the crafting of the “explanation” is the common thread that runs through both my clinical work as a physician, and my work as an animator/illustrator. Just as it is critical that I effectively communicate the explanation to a clinic patient, I must also take the important points of a medical-legal case and convert them into a visual form which simplifies the concepts as much as possible without stripping them of their essence. The positive return in a legal case is not as direct or immediate as when working with a clinic patient, but it feels good when one learns that your contributions have aided in returning a favorable verdict.
Ah, the symbiosis of the dual life…