Page 26 - Volume 70 Number 2
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day. There was no autopsy. I’m glad I wasn’t there. At breakfast after morning rounds on Monday I could sense the hush of disaster past. I had the distinct feeling that morning that no one knew just how to break it. Finally, when the expected had become obvious, the senior resident, Lois, said, I hope you don’t mind our not calling you at 6 AM yesterday. I did, but I didn’t. I had really expected that A.S. would be gone when I got back from the weekend, but I wasn’t fully relieved by the news of his death. I said, no, not really, and that was all.
There was one little triumph toward the end of the rotation at the Children’s I must tell about. On Wednesday of our last week there, Steve Hall, Art Boylston and I were assigned to discuss a CPC case. We were given a case history, but the information we were given was typically vague: “it just didn’t tell you anything.”
None of the three of us spent much time working
on the CPC, so that by Wednesday morning we had absolutely no idea what we were going to say in our discussion or what our \[student\] diagnosis was going
to be. Early in the morning, however, I happened to be down in the x-ray department and, struck suddenly by the idea, I asked Dr. Neuhauser \[the distinguished pediatric radiologist\] to go over the films of the CPC
with me, which he was happy to do. Not only was his interpretation different from the one given \[in the chart\], but also, he gave us his differential diagnosis – mostly congenital cardiac and cardiopulmonary anomalies, but one, “cor triatriatum,” had that ineffable quality of obscurity and remote possibility that makes horse racing.
I missed the official CPC because of \[a conflicting engagement\] but Steve Hall was delegated to give our diagnosis: congenital heart disease, most likely cor triatriatum,” \[at the appropriate time\]. As the scene was described to me later, and I can envision it well, Gordon Vawter \[pathology\] ambled to the podium after the discussion in which an English fellow named John Lorber from Sheffield, U. K., gave a diagnosis of idio- pathic pulmonary hypertension, and drawled, “what is the student’s diagnosis?” When Steve dropped the bomb, Vawter’s jaw dropped about 3 inches and the audience buzzed and chuckled, because the stud(ent)s had done it again. Vawter was so flustered that he asked how we arrived at that diagnosis and Steve, who was obviously not prepared to answer that question, admitted to
Dr. Neuhauser’s aid, but the coup was complete, nonetheless. All’s fair....
At the end of the week, I would move on to Gynecology at the Peter Bent Brigham.
By Alon Weizer, MD
I don’t know how you feel, but the term “provider” really bugs me. At first I tried to let it go but as more and more people use the terminol- ogy to refer to people who care for others, I find it harder to ignore. I understand why the term is used. It is an easy way to describe a class of professionals who spend their time “providing care.” It is egalitarian in that it does not draw a distinction based on what type of training that “provider” has been through.
I won’t go as far as using the word “hate” but I really dislike being referred to as a provider and it’s probably not for the reasons you might think. I don’t care that we are lumping doctors in with other health care professionals. I value the diverse expertise and experience of all of those who dedicate their work to helping care for patients and communities and recognize that the complexity of medicine requires a broad range of expertise that no one individual can deliver on their own. And that is the primary reason I do not like the term provider. I am not providing a service. I am caring for my patient, their family, and often times building long-term therapeutic relationships that cannot be summed up by the term provider. The take home message is that calling any of us providers fundamentally diminishes what we should be aiming for as health care professionals. So much of medicine has been reduced to a transaction but if we are truly going to provide better health and well-being for those we care for, we have to move beyond the delivery of a service to trying to prevent disease, promote wellness, and have informed conversations with patients when intervention may or may not be indicated.
In exploring my feelings, there are two reasons I believe that “provider” bothers me so much. First, as we learned early on in life, words matter. I am avoiding a political discussion here, but the point is that words can alter decisions, create bias, and even influence outcomes. So having others define me as a provider, even if it is for a report or commonly used terminology nationally, ignores my years of training and experience and does not capture who I am or what I do. The second reason is really inter- related to this first. Its human nature to label and define others. In some ways, it is a necessary evil. If I say apple, you do not think I am talking about a banana, but rather visualize a red or green fruit that is relatively round with a stem. It’s easier for me to give you a single word than describe in detail something each time. But most of us (including me) who have spent a lot of their life being defined by others have grown tired of it. The focus on diversity, equity, and inclusion have taught me that allowing people to define themselves is important in creating a culture where everyone is valued and bias is reduced.
Washtenaw County Medical Society BULLETIN APRIL / MAY / JUNE 2018

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