Bored? ... I hope not

Several years ago, someone asked me if I ever became bored at work. As I recall my inquisitor was an internist, and I assume that his question was based on the assumption that a general pediatrician sees only a limited varieties of illnesses ... runny noses, ear infections, sore throats, diarrhea, and a few others. And, of course, most of the problems involve only one organ system, and very few of them are life threatening. To someone who finds disease interesting and enjoys the complicated interplay that accompanies multiorgan system failure, I guess primary care pediatrics might appear rather ho-hum.

But, for several reasons, I have never found pediatric practice boring. There is always the threat that hidden in the forest of children with garden-variety illnesses, there are always a few who have serious life-threatening conditions. When it feels as though more than half of the patients I have seen in a morning have a viral sore throat, it is tempting to put one’s diagnostic machinery on cruise control and just sort of go through the motions. But, the next patient I see may be brewing a prevertebral abscess. It’s not very likely, but if I had allowed myself to doze off at the wheel and had sent the child home with inadequate or poorly understood instructions, both the child and I could be in big trouble. Obviously, my first concern is for the welfare of the patient. However, we all must admit that the threat of malpractice suit can be a potent motivator and strong deterrent against boredom.

I suspect that I have always enjoyed looking at what some might consider boringly repetitive patterns because I get some satisfaction searching for the outliers. As a teenager, I spent my summers as a lifeguard scanning a pool full of bobbing young bodies, all the while looking for that one child whose splashing wasn’t playful. Instead, it was a distress call.

The concern about missing serious illness can help a physician remain focused when the landscape of normalcy takes on a dull shade of monotony, but that level of engagement can only last so long if her focus is primarily disease. I recently learned that it was Hippocrates who is reported to have said, "It is more important to know what sort of person has a disease than what sort of disease the person has."

If that old Greek physician/philosopher followed his own advice, I’m sure he was never bored. A pediatrician, or any physician for that matter, whose focus is on disease is going to find out that after a year or 2 of practice, she has seen just about all the variety she is going to see. Of course, every now and then a zebra is going to wander into her exam room, but she had better have something else to keep herself engaged while she is waiting for the next zebra.

However, every patient with a sore throat is a unique individual. One may be very anxious. One may minimize his complaints. One may believe antibiotics cure everything, and the next may have an unvoiced concern that he has caught a sexually transmitted infection from oral sex. Each patient has her own way of manifesting a disease and her own unique story. It may be sitting there on the surface, but sometimes we have to scratch and dig to find what’s really causing patients to react as they do.

At times, there is no substitute for the correct diagnosis. But, if the physician fails to understand the patient, the correct diagnosis may not be accepted and even the appropriate therapy won’t be effective. Often, we don’t know the diagnosis, and then it is critical to understand the patient’s tolerance for uncertainty.

The list of potential diseases that one physician will see in her career is rather short. However, she will encounter thousands of patients, each one with his or her own unique way of dealing with those few illnesses. If she finds that boring, it’s time to find another career, preferably one that provides minimal exposure to people.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

Several years ago, someone asked me if I ever became bored at work. As I recall my inquisitor was an internist, and I assume that his question was based on the assumption that a general pediatrician sees only a limited varieties of illnesses ... runny noses, ear infections, sore throats, diarrhea, and a few others. And, of course, most of the problems involve only one organ system, and very few of them are life threatening. To someone who finds disease interesting and enjoys the complicated interplay that accompanies multiorgan system failure, I guess primary care pediatrics might appear rather ho-hum.

But, for several reasons, I have never found pediatric practice boring. There is always the threat that hidden in the forest of children with garden-variety illnesses, there are always a few who have serious life-threatening conditions. When it feels as though more than half of the patients I have seen in a morning have a viral sore throat, it is tempting to put one’s diagnostic machinery on cruise control and just sort of go through the motions. But, the next patient I see may be brewing a prevertebral abscess. It’s not very likely, but if I had allowed myself to doze off at the wheel and had sent the child home with inadequate or poorly understood instructions, both the child and I could be in big trouble. Obviously, my first concern is for the welfare of the patient. However, we all must admit that the threat of malpractice suit can be a potent motivator and strong deterrent against boredom.

I suspect that I have always enjoyed looking at what some might consider boringly repetitive patterns because I get some satisfaction searching for the outliers. As a teenager, I spent my summers as a lifeguard scanning a pool full of bobbing young bodies, all the while looking for that one child whose splashing wasn’t playful. Instead, it was a distress call.

The concern about missing serious illness can help a physician remain focused when the landscape of normalcy takes on a dull shade of monotony, but that level of engagement can only last so long if her focus is primarily disease. I recently learned that it was Hippocrates who is reported to have said, "It is more important to know what sort of person has a disease than what sort of disease the person has."

If that old Greek physician/philosopher followed his own advice, I’m sure he was never bored. A pediatrician, or any physician for that matter, whose focus is on disease is going to find out that after a year or 2 of practice, she has seen just about all the variety she is going to see. Of course, every now and then a zebra is going to wander into her exam room, but she had better have something else to keep herself engaged while she is waiting for the next zebra.

However, every patient with a sore throat is a unique individual. One may be very anxious. One may minimize his complaints. One may believe antibiotics cure everything, and the next may have an unvoiced concern that he has caught a sexually transmitted infection from oral sex. Each patient has her own way of manifesting a disease and her own unique story. It may be sitting there on the surface, but sometimes we have to scratch and dig to find what’s really causing patients to react as they do.

At times, there is no substitute for the correct diagnosis. But, if the physician fails to understand the patient, the correct diagnosis may not be accepted and even the appropriate therapy won’t be effective. Often, we don’t know the diagnosis, and then it is critical to understand the patient’s tolerance for uncertainty.

The list of potential diseases that one physician will see in her career is rather short. However, she will encounter thousands of patients, each one with his or her own unique way of dealing with those few illnesses. If she finds that boring, it’s time to find another career, preferably one that provides minimal exposure to people.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

Several years ago, someone asked me if I ever became bored at work. As I recall my inquisitor was an internist, and I assume that his question was based on the assumption that a general pediatrician sees only a limited varieties of illnesses ... runny noses, ear infections, sore throats, diarrhea, and a few others. And, of course, most of the problems involve only one organ system, and very few of them are life threatening. To someone who finds disease interesting and enjoys the complicated interplay that accompanies multiorgan system failure, I guess primary care pediatrics might appear rather ho-hum.

But, for several reasons, I have never found pediatric practice boring. There is always the threat that hidden in the forest of children with garden-variety illnesses, there are always a few who have serious life-threatening conditions. When it feels as though more than half of the patients I have seen in a morning have a viral sore throat, it is tempting to put one’s diagnostic machinery on cruise control and just sort of go through the motions. But, the next patient I see may be brewing a prevertebral abscess. It’s not very likely, but if I had allowed myself to doze off at the wheel and had sent the child home with inadequate or poorly understood instructions, both the child and I could be in big trouble. Obviously, my first concern is for the welfare of the patient. However, we all must admit that the threat of malpractice suit can be a potent motivator and strong deterrent against boredom.

I suspect that I have always enjoyed looking at what some might consider boringly repetitive patterns because I get some satisfaction searching for the outliers. As a teenager, I spent my summers as a lifeguard scanning a pool full of bobbing young bodies, all the while looking for that one child whose splashing wasn’t playful. Instead, it was a distress call.

The concern about missing serious illness can help a physician remain focused when the landscape of normalcy takes on a dull shade of monotony, but that level of engagement can only last so long if her focus is primarily disease. I recently learned that it was Hippocrates who is reported to have said, "It is more important to know what sort of person has a disease than what sort of disease the person has."

If that old Greek physician/philosopher followed his own advice, I’m sure he was never bored. A pediatrician, or any physician for that matter, whose focus is on disease is going to find out that after a year or 2 of practice, she has seen just about all the variety she is going to see. Of course, every now and then a zebra is going to wander into her exam room, but she had better have something else to keep herself engaged while she is waiting for the next zebra.

However, every patient with a sore throat is a unique individual. One may be very anxious. One may minimize his complaints. One may believe antibiotics cure everything, and the next may have an unvoiced concern that he has caught a sexually transmitted infection from oral sex. Each patient has her own way of manifesting a disease and her own unique story. It may be sitting there on the surface, but sometimes we have to scratch and dig to find what’s really causing patients to react as they do.

At times, there is no substitute for the correct diagnosis. But, if the physician fails to understand the patient, the correct diagnosis may not be accepted and even the appropriate therapy won’t be effective. Often, we don’t know the diagnosis, and then it is critical to understand the patient’s tolerance for uncertainty.

The list of potential diseases that one physician will see in her career is rather short. However, she will encounter thousands of patients, each one with his or her own unique way of dealing with those few illnesses. If she finds that boring, it’s time to find another career, preferably one that provides minimal exposure to people.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.