Edward S. Hume, M.D., J.D.
Knowing and Doing
last updated 11/30/96
Internists know everything but do nothing
Surgeons know nothing but do everything
Psychiatrists know nothing and do nothing
Pathologists know everything and do everything, but too late
Anesthesiologists sit on a stool all day and pass gas
To be is to do --- Descartes
To do is to be --- Sartre
Doo bee doo bee doo --- Sinatra
We've all heard this joke:
Someone calls a plumber or electrician for an emergency house call. He listens to the problem, then takes a hammer or wrench and hits the wall, which fixes the problem. He then asks for $100.
The homeowner, outraged, demands an itemized bill. The craftsman writes, "Hitting wall: $5. Knowing where to hit: $95."
When I was a medical student, one of my rotations was chest surgery. One of the attending chest surgeons was a famous lung specialist, who had pioneered an important technique in the 1940's. At the time of my chest surgery rotation in 1973, he seemed to specialize in lung cancer surgery. The man smoked! He also had a serious intention tremor (his hands shook when he did something with them).
In fact, this surgeon did no cutting or sewing on patients. The chest surgery residents did all of that. What he did do was this: he would personally look at the frozen section slides from the tumor biopsy along with the surgical pathologist. Then he would palpate (put his hand in and feel) the exposed tumor and the surrounding tissue. He would decide whether the tumor was resectable (whether the tumor should be surgically removed) and how best to do it. Then he would supervise the resection --- sometimes cut by cut, stitch by stitch --- with smoking breaks outside the OR suite (clearly, times were very different then).
As you consider this, you should know that to be a chest surgery resident a doctor must complete a residency in general surgery. In effect, the resident is a fully-trained general surgeon. The attending chest surgeon was not leaving the cutting and stitching to amateurs.
Although he might have retired when he was no longer able to do the actual physical work of surgery, this doctor stayed in practice. It is my belief that by doing so, he was able to extend the lives and comfort of some very seriously ill patients.
So, despite the canards above, surgeons really do know something. And
the whole issue of expertise is worth thinking about as telemedicine (physicians
diagnosing and recommending treatment from a distance) is becoming more and
more practical. People are already starting to do it in psychiatry…
Managed Care Executive
Once an executive for a managed healthcare firm died and woke to find himself in Heaven. He exclaimed. "What am I doing here?"
His roommate replied, "You must belong here. God doesn't make mistakes."
"But I'm a managed care executive," the man said. "I designed systems to be so hard to use that patients would get discouraged and not get care, and doctors would get disgusted and just work for free. I denied people reimbursement for help they needed. I made hell for everyone else. I was not a nice guy."
"Well," his roommate replied. "You might ask St. Peter. He has the Book of Life."
So the healthcare executive went to the Pearly Gates and asked St. Peter
if he truly belonged in Heaven. St. Peter looked in the Book of Life and
said, "Do you belong here? Sure! You've been approved for three days."
What is the difference between
a nun and a nurse?
The nun has only one god to answer to.
(this fits with another old one: the "MD" stands for "Medical Deity")
What do accountants use
for birth control?
--- their personality
(Thanks, Bruce)
The basic functions of behavior are the Four F's:
Fleeing
Fighting
Feeding
and Reproduction
--Bessel van der Kolk, June 1996
There was a religious man caught in a flood. Waters rose and he took to the roof. A rowboat came by but he declined their offer of assistance. Then a motorboat arrived, but he again declined help. Finally a helicopter flew up, but he waved them off. "I trust in the Lord and he will save me" he said to each offer of help.
Eventually he drowned.
Once in heaven the said to God, " My faith never wavered! How could you let me down?"
"Let you down?" thundered God. "I sent a rowboat, a motor boat, and a helicopter. What were you waiting for?"
(contributed by Dr Richard Robinson MB, BS --- rrobinso@compusmart.ab.ca)