Monday, November 29, 2010

Monday November 29, 2010

Another long holiday call weekend has come to a close.  Once again, in the words of one of my attendings during fellowship, it was not the lions and elephants but the gnats and fleas that bothered me the most.  Particularly frustrating is the inability or unwillingness of physicians to take an adequate history, relying instead on a "shotgun" approach to the evaluation of patients--ordering an array of laboratory studies and diagnostic procedures (what I like to call rounding up the usual suspects), then moving on to the next admission.  Coincidentally, the latest edition of the Methodist Debakey Cardiovascular Journal appeared on my desk this morning, and two articles caught my attention: one a tribute to Dr. Michael E. Debakey, the other a memorial to Dr. William R. Gaston, who passed away in March.  It was from them, and my other professors at Baylor, that I learned the value of the patient's history, a lesson that was taught by example, on a daily basis, at bedside.  If history taking is becoming obsolete, we face far more serious problems than simply the rising costs of healthcare.

Swam at Nitro this morning with David, Steve, Anthony, and Jeff.  Stephen coached.

500 swim
10 x 50 @ 1:00, working on "walls", averaged :33-:34
4 x (4 x 100), descending intervals (1:35, 1:30, 1:25, 1:20), 1:00 rest between rounds; averaged 1:08-1:09 (1000 race pace), HR = 1:32-1:38.  I skipped a fifth round (@ 1:10) as I am beginning my taper.
200 easy


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