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CHAPTER 4: The Art of Seeing

Dr. Herbert Ho Ping Kong ECW Press ePub

CHAPTER 4

The ART of SEEING

Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.

— Sir William Osler

WHEN WE FIRST ARRIVED IN MONTREAL, my wife and I initially planned to stay for three years, and then assess our professional situation. As it happened, our third anniversary in 1976 roughly coincided with the surprise election of the separatist Parti Québécois, led by the mercurial journalist-turned-politician René Lévesque.

The election results sent the anglophone community in Quebec into a state of shock. I vividly recall walking into Royal Victoria Hospital, at the north end of the McGill University campus, at 9 a.m. on the morning after the election and finding it virtually deserted. The corridors, coffee shops — completely empty. It was as if an official order had been issued to vacate the entire premises.

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CHAPTER 9: Thinking Outside the Box

Dr. Herbert Ho Ping Kong ECW Press ePub

CHAPTER 9

THINKING OUTSIDE the BOX

Discovery consists in seeing what everyone else has seen and thinking what no one else has thought.

— Albert von Szent-Györgyi, Nobel Prize–winning physiologist

IF PRACTISING THE ART OF MEDICINE is principally about bringing more humanity to the doctor-patient relationship, it is not only about humanity. Part of it involves devising creative approaches to diagnosis and treatment, or what I like to call out-of-the-box thinking.

I’m not sure how — or even whether — you can teach future generations of doctors to develop out-of-the-box thinking. The best analogy may be music. You usually need to have years of experience and exposure to the classic forms before you can begin to play jazz. Similarly, in medicine, I would argue that you need to have a broad and deep grasp of basic medicine before you can consider adopting more experimental tactics.

Regardless, it is certainly a skill that physicians young or seasoned would find useful. Quite frequently, disease does not present with the expected or familiar pattern. Especially in an age of multi-system medical problems, disease (and the treatment of it) is becoming a moving target, and physicians need to be agile enough to move with it. I can recall six or seven cases in particular that will help demonstrate what I mean.

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CHAPTER 3: Lessons of the Montreal Years

Dr. Herbert Ho Ping Kong ECW Press ePub

CHAPTER 3

LESSONS of the MONTREAL YEARS

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

— Sir William Osler

THE HARD DECISION TO EMIGRATE having been made, I now faced another thorny question: where exactly to go. A number of friends and colleagues had happily moved to the United States, and I did receive a few informal American overtures. But my first preference was Canada, which I judged to be a gentler society.

Accordingly, I sent letters of introduction to the chiefs of medicine at hospitals in several major Canadian cities. General internists were not in high demand at the time, so I was not exactly deluged with offers. But I did receive replies about potential positions in Halifax, Edmonton and St. John’s. I made a visit to Ottawa, but was discouraged by the February snowbanks that literally reached to the eaves of houses. And one Toronto physician-in-chief expressed interest, but with a caveat: he wanted me to effectively audition in private practice for a few years before applying for a staff position.

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CHAPTER 8: Further Excursions in the Grey Zone

Dr. Herbert Ho Ping Kong ECW Press ePub

CHAPTER 8

FURTHER EXCURSIONS in the GREY ZONE

The physician should not treat the disease, but the patient who is suffering from it.

— Maimonides

IN THE LAST CHAPTER, I REVIEWED a series of cases dealing with the complex challenges that physicians face in dealing with syndromes that cannot be clearly identified, despite the obvious physical and mental suffering they inflict on patients. In this chapter, I will look at a few cases in which we can make a firm diagnosis of physical illness, but offer no effective or lasting solution. Here, the art of medicine is likely to be measured by other factors — by the level of care, attention, empathy and advocacy a doctor brings to the bedside. Sadly, in such situations, it is often necessary to deliver bad news to these patients. But that, too, is an art that needs to be developed.

A FEW YEARS AGO, A COLLEAGUE at a nearby hospital referred a very difficult case to me. Marnie was a 40-year-old woman that had been diagnosed with Erdheim-Chester disease. First identified by two pathologists in the 1930s — Austrian Jakob Erdheim and American William Chester — the syndrome is characterized by excessive production of histiocytes, a type of white blood cell that the body normally deploys to fight infection. When histiocytes over-produce, however, they invade the body’s connective tissue and begin to play havoc with key organs, including the heart, bone, kidneys and liver.

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CHAPTER 5: The Art of Listening

Dr. Herbert Ho Ping Kong ECW Press ePub

CHAPTER 5

The ART of LISTENING

Listen to your patient. He is telling you the diagnosis.

— Sir William Osler

SEVERAL YEARS AGO, A CHINESE-CANADIAN named Charles developed a nagging pain in his back. He was about 56 years old and, though he had prospered since he’d immigrated, and managed to save enough funds to own a building, he continued to work as a labourer, loading boxes of vegetables on and off delivery trucks. He continued to work through the pain for about a month but, eventually, it grew so severe that he had to stop. Through his employer, Charles consulted an orthopedic specialist retained by the Workers’ Compensation Board. The doctor diagnosed osteoarthritis and prescribed painkillers.

But by then, Charles had also started to lose weight. He was sent for a series of tests, which indicated the presence of red blood cells in his urine. That finding raised the possibility of kidney disease, so he was sent to a nephrologist who did further tests, confirming that Charles’s urine contained blood, and suggested that he might have IgA (immunoglobulin A) nephropathy, a common kidney disease that affects the organ’s filters, or glomeruli. Although the condition is mostly benign, the kidney may, over time, lose its ability to cleanse the blood properly.

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