The Cheerful Oncologist

As many ScienceBlogs readers know by now, last month Popular Mechanics published a list on their website of “25 Skills Every Man Should Know,” which included such esoteric talents as “frame a wall” and “extend your wireless network.” How these two made the list over such accomplishments as “find tickets to a Hannah Montana concert,” or “pass gas anonymously on an airplane flight” is beyond me, but then again I’m a doctor, not a popular mechanic.

Just for fun I’d like to share my version of this meme, so without further ado here is a list of 25 skills every doctor worth his or her salt should be able to do. The list is in no particular order and is my opinion only. Any omissions or refutations may be listed in the peanut gallery section of this post.

Skills all doctors should possess:

1. Recognize when a patient needs to be transferred to the ICU.

2. Deliver bad news compassionately, yet honestly.

3. Identify a pneumothorax on a chest radiograph.

4. Diagnose iron deficiency anemia.

5. Help a patient stop smoking cigarettes.

6. Diagnose thrombotic thrombocytopenic purpura, which has a mortality rate of 90% if not treated and 10-20% if treated.

7. Distinguish between the various tachyarrhythmias.

8. Explain a disease or procedure to patients in plain, understandable terms.

9. Use the internet to find medical information and references.

10. Know when to speak, and when to listen.

11. Practice what they preach, especially when it comes to a healthy diet.

12. Take a blood pressure.

13. Find enlarged lymph nodes or splenomegaly on examination.

14. Know when to call in a consultant and when to do the work themselves.

15. Successfully treat hypertension, or find a doctor who can.

16. Refer a patient to the right specialist at the right time, or at least within a reasonable time period.

17. Be unafraid to say “I don’t know.”

18. Understand the precious value of time, both theirs and their patients’.

19. View their medical colleagues as a source of support, information and camaraderie.

20. Treat nurses and other staff in a courteous and professional manner.

21. Learn the gentle art of patience, patience and more patience.

22. Keep up with important advances in health care and research.

23. Never let anger, the killer of careers, interfere with the mission at hand.

24. Be able to always, always, have a plan of action to help a patient.

25. Appreciate the unique gifts each physician carries within, and never let a tough day become an excuse to withhold them from those who need them the most.

P.S. I deliberately left out such things as “knowing how to perform CPR” – such mundane tasks are assumed to be universal to all doctors.

Comments

  1. #1 Rob
    October 24, 2007

    Nice list. Interesting that you put TTP on the list (as an oncologist). I put Menigiococcal disease on my list, as it is so quick. The key is to know what diseases you should never miss.

  2. #2 Elizabeth
    October 24, 2007

    Great list, and if there’s room for number 26, it should be: Dictate intelligibly.

  3. #3 Christian
    October 24, 2007

    TCO,

    Great list. As I read it it reflected a lot of the skills I did not learn in medical school or particularly in residency. A lot of the skills you list seem to resonate with experience. For some that experience comes fast because they are open to it, for others it doesn’t matter how many times they screw up, they never see the learning opportunity.

    I will probably make a ref to this in an upcoming post since many of these things resonate with palliative medicine. Thanks again for constructing this great list.

    I agree with Elizabeth as well.

  4. #4 pilgrimtinker
    October 24, 2007

    Great list. I pointed to it on my blog because I was gratified to see the importance you place on good communication with patients-#8. While I am no judge of the relative values of the strictly medical items, I was inspired by the kindliness and professionalism of the rest of the list. Next time you need some help with #9 or #22, seek out a good medical librarian- you’ll find another kind of colleage passionate about quality patient care.

  5. #5 GruntDoc
    October 25, 2007

    You’re assuming CPR is a universal physician skillset. It’s not, from my days of responding to in-house codes.

    Fun list, would be interesting to see a ’25 things every doc should know’ from every specialty.

  6. #6 Deidre Alejo
    October 25, 2007

    Number 25 really needs attention in the oncology arena….To be left to fend for yourself, I am still stunned.

    My oncologist told me I was terminal and only palliative chemotherapy was the only option left, which is not an option at all. He would not look into Low dose Naltrexone and even now that I am stable will not even respond to my updates or charts.

    “Only 10% of the oncologists would prescribe at least one type of CAM and this attitude correlated significantly with previous physicians’ use of CAM and with being a clinical oncologist as well as with having questioned patients about CAM use. Most oncologists (80.7%) would not indicate the use of CAM, mainly for lack of scientific proof of its efficacy (56.2%). Click here for article.

    With the number of people who are dying with conventional oncology it amazes me why alternatives are not embraced by the oncological community who peddle their treatments which make you sick and in most cases add only a few painful months to a patients life.

    Low dose Naltrexone public awareness needs to be significantly increased so more can be helped. With the hope of 6 clinical trials commencing in 2008 with LDN, maybe this conference will be the catalyst for all those in need in 2008.

    I know it has saved my life,

    Dee
    http://www.ldn4cancer.com/

  7. #7 The Cheerful Oncologist
    October 25, 2007

    To Dee,

    I understand your enthusiasm regarding the opiate antagonist naltrexone, but as my CAM-debunking buddy Orac would say, “Show me the data.”

    The Naltrexone cases provide insufficient indications to determine the likely benefit for Naltrexone at this time. For IAT, this review suggests there is sufficient evidence to recommend that a random controlled trial could be considered. For Naltrexone, a prospective cohort case series should be considered.

    This excerpt is from a 308 page report written by the U.S. Department of Health and Human Services on certain CAM therapies including naltrexone. Until the results of well-designed randomized clinical trials are released there is no reason to hawk naltrexone as a miracle cure. That said, scientists do recognize the anti-proliferation effects of naltrexone on malignant cells and research will definitely continue.

    The link to this lengthy report is below. WARNING: it is a 15 mb download.

    http://www.ahrq.gov/downloads/pub/evidence/pdf/immaug/immaug.pdf

  8. #8 Flightfire
    November 1, 2007

    I would also put “Deliver a baby” on that list. Seems like a skill that not a lot of people have that is just expected of doctors.

  9. #9 Sara
    December 5, 2007

    In medical school, one of the hematologists insisted on failing any student who missed TTP diagnosis on a test question. So we all knew it pretty well. In fact, the computer system at the hospital pops up a flag that says, “Consider TTP” anytime there is anemia, thrombocytopenia, and maybe clotting factors off.

    Glad to see it wasn’t them caving to some peculiarity of his, that someone else agrees with him.

  10. #10 youtube
    February 24, 2008

    Glad to see it wasn’t them caving to some peculiarity of his, that someone else agrees with him.

  11. #11 youtube
    March 7, 2008

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  12. #12 youtube
    March 7, 2008

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    March 20, 2008

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    March 23, 2008

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    March 24, 2008

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    March 28, 2008

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    March 28, 2008

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