about medical tacts and talents

Archive for the month “October, 2013”

Saluti, caro dottore!

saluti caro dottore
Under this delightful Italian salutation I wish to emphasize the importance of language for the physician. Indeed, language use and mastering is one of the big challenges to be a good physician provided that good and gentle contact with the patient constitutes in most cases the secret word towards cure and release. This fact is very striking when caring for a patient of different language and culture. The patient would be so surprised and impressed when the doctor utters his/her own language words in an agreeable manner dispensing the need for an interpreter. This should be a preliminary reason to achieve patient’s confidence and cooperation. Again, the patient’s description of the present complaint in a language that is felt and tasted should help the physician to resolve the case much more precisely. The wonders of good language communication are far away from being simply listed especially when pain to be relieved and suffer to be eased.

The rendezvous with the language does not stop at containing the many Latin and Greek words and terms but the physician maybe appointed to walk a long and interesting experience with learning and practicing many tongues to help maintain good communication with people and refine the health care provision.

“Are you going to be a specialist? Or just a GP?”

Nomadic GP

“Are you going to be a specialist? Or just a GP?”

As a medical student and junior doctor in my hospital training years, I was often asked this question by friends, senior doctors and well meaning patients.  It really grated on me, that one little word: “just”.

I always thought I’d become a GP. As a teenager, I was inspired to study medicine by my own GP who had always looked after my family with such care and compassion.  As I went through my training I dabbled with the idea of other specialties; I was fascinating by the life stories of my geriatric patients, I loved the cute-factor of paediatrics, I was hooked on the emotional highs and lows of obstetrics, I enjoyed the team atmosphere of the emergency department. But I think, deep down, that I always knew I liked ALL of medicine too much and that above all I…

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Physician! Why not?

physician 2
A sweet dreamy child is fond of various amusing, challenging and curious items. From playing hide and seek through living in a cartoon to flying far with a cup of fruit glace. A mark of talent and infinite will to joy and dream. Yet, the questions would visit the little genius, who finds always simple and lovely answers; “When I grow up, I would get married and have a fridge full of food and fruits.” So, the little sees the promising lovely future. Not once seen singing like popular singers, glowing in matches like the best footballers or drowning in thinking and trial like a great scientist or a philosopher. We got a treasure of abilities waiting for love, care and refinement. Such genius will find many chances to show admiration to goodness and creativity.

What? Would I be a doctor? The word sounds me very nice. I like the person too, full of passion, wisdom and respect. I don’t know a doctor in my family but I feel like I am stolen by the word and its reflection. I like to help everybody especially the needy people and those who are sick and weak. A doctor puts on a shiny white coat, gives prescriptions and can save lives by doing surgery. I can agree generally with all this but in fact it is the word – doctor – that interests me this time, the word itself not the job. I can live with such a word that sounds in my ears and soul like a mercy of an endless spring.

The physician has preliminary physical, social, financial, moral and intellectual conditions that suit the requirements for interrogating, examining and treating patients. Besides this the physician may have the opportunity to do medical research in basic and/or clinical studies that may necessitate the engagement in a team work of other disciplines like engineering, physics, chemistry and biology. Though the work of a physician is almost a matter of continuous training and practice, yet this work is largely dependent on the way how data are managed and saved. Nice and efficient data handling should help the physician for better results with less effort, cost and time.

And now, to a brief note about the progress of medical practice that I wish to be useful:
– Leeuwenhoek makes the first microscopes (1673).
– Lavoisier discovers the conservation of mass (1774).
– Avogadro defines the mole as a unit of mass for chemical reactions (1811).
– Jenner discovers the vaccination (1796-1811).
– Robert Koch puts postulates for infectious diseases (1890).
– Rontgen discovers the X rays (1895).
– Fleming discovers the penicillin (1928).
– Watson and Crick deduce the chemical structure of the DNA (1953).
– The complete sequence of the human genome is known (2003).
Practicing medicine is a job that should be given out of both knowledge and admiration. Enjoy it!

The clapper and the intonation room, a hypothetical medical context

the clapper and the intonation room
In medicine it is usually reasonable to consider the clapper (the heart) together with its intonation room (the lungs). The cardiorespiratory cycle may, therefore, be considered one entity and should be split only for simplicity. The academic question in this point is how the two phases of respiration are orchestrated with the two phases of cardiac cycle, from one side, and with the concurrent gas/metabolite exchanges in the lungs and tissues, from the other side. Although I did not yet look for an authenticated answer, I would like to present in this text a hypothetical model based on common sense and the concept of lung compliance.

The clapper has got in intrinsic rhythmicity and alternates between contraction (systole) and relaxation (diastole). Although the serial 4- station pass of blood (the cardiac cycle) would be very exciting, i.e. right atrium > right ventricle > left atrium (through the lungs) > left ventricle (to systemic circulation), and might be apparently conforming with the site of SAN and AVN and the path of nerve impulse conduction, a 2- station pass may be described in text books, in which model the right and left hearts are switched in parallel. Yet, to fulfill my scientific fantasy, even a minor right to left lag might be present.

As the right ventricle contracts blood goes to the lungs (through the pulmonary arteries), and the lungs increase minimally in volume due to elastic recoil of the pulmonary arteries. Meanwhile, the volume of the lungs may be increased by inspiration. Such an increase in lung volume by inspiration is not factually essential for right ventricular contraction to happen with more ease because normally lung resistance is quite small to accommodate an average right ventricular systole. The presumption here is that right ventricular systole is orchestrated with an inspiration, i.e. the inspiration may be almost synchronous with the systole but not necessary equal in length. Because of the phenomenon of lung hysteresis, I may guess that expiration is more concerned with gas exchange in the lungs than inspiration may be (the model may be instantaneous more than sloping in this regard) and this would suggest that right ventricular diastole, when no more blood is ejected into the lungs, is almost synchronized with expiration as air is exhaled out; right ventricular systole/ lung inspiration > right ventricular diastole/ lung expiration, and this would be my hypothesized cardiorespiratory cycle (1).

The same idea may be applied on the left heart: left ventricular systole/ arterial recoil and capillary refilling > left ventricular diastole/ capillary resilience, when almost gas and metabolite exchange takes place between blood and tissues, i.e. again a more instantaneous than sloping model is suggested (2). The movement of fluid in the vicinity of the capillaries would follow a rather sloping model where a fluid outflow gradient on the arterial side of the capillary may be appropriately counterbalanced by another fluid inflow gradient on the venous side.

I may be eligible to confer this package of cardipulmonary assumptions the term: Gharabawy’s cardiorespiratory axioms. Though the right blood circulation may seem shorter than the left one, the total paths of deoxygenated and oxygenated blood seem to be equal. The two assumptions noted above as (1) and (2) can be represented as follows:
the clapper and the intonation room 2 (2)

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