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Emergency Medicine News:
doi: 10.1097/01.EEM.0000441168.06932.f4
Second Opinion

Second Opinion: Thanks, Osler, but Kudos to the Chemists, Engineers, and Factory Workers

Leap, Edwin MD

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Dr. Leap is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of three books, Working Knights, Cats Don't Hike, and The Practice Test, and of his own blog.

Think for a second about the most treasured drug or device in your medical bag. Or about the procedure you find most appealing, the disease or injury you most enjoy treating. I really enjoy doing lumbar punctures, opening abscesses, placing IO lines, and applying splints. Because I'm an emergency physician, I am duty bound to say that I love to intubate. And I do.

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I also enjoy doing nerve blocks, whether dental, regional, or digital. In fact, I did my own digital block on my very painful great toe which was sporting an ingrown nail. I endured it for about one month, believe it or not, but ultimately I was too cheap to go to my doctor or any other doctor. So I sat down in my bathroom with my wife and kids in attendance. Just before I started, I said, “I don't think I can do this to myself!” to which my insulin-dependent son, Seth, replied, “Are you kidding me?” The shame worked, and the bupivicaine left my toe tingling for 12 hours.

The point I want to make isn't that I'm good at blocks or you're good at chest tubes or any other such self-congratulatory drivel. The point is, I may be able to do a darn good nerve block, but I didn't invent syringes, I don't manufacture needles, and I haven't the foggiest idea how to make a local anesthetic.

And as proud and puffed up as we all may be at times with our advanced techniques and our nifty procedures and tools, the plain truth is that as physicians, we stand on the shoulders of some very brilliant people.

I am reminded of my relative incapacity whenever I'm asked to check on a sick or injured person outside the device- and drug-filled walls of the emergency department, at church perhaps or at a party. I'll gladly check a pulse, feel for a fracture, assess breathing and neurologic status. I'll happily do chin lifts and jaw thrusts and even CPR if needed. But in the end, I call 911 or say, “You better go to the ER” because much of what I can do is dependent on a whole host of tests, drugs, and devices that we seldom have tucked in our back pockets.

Our compassion for the sick and injured and dying has been around since the first “physician” knelt beside someone he loved, and decided to stay by his side to help him. Our diagnostics have evolved since that time. Our medical ancestors were darn good at looking, listening, touching, and smelling, then pronouncing hope or doom. I imagine in an age in which we are increasingly separate from the bedside that those same medical ancestors could give us a run for our modern (increasingly inflated) money when it comes to diagnostic prognostication. But the things we use every day to increase our diagnostic skills (labs and x-rays and cardiograms and ultrasound) and the things we use to save life, prolong life, and ease suffering have changed dramatically in the past century. And we sure do need them.

We may go on and on about Osler and Halstead and all of the other greats of medicine. But we must also nod to Roentgen and Fleming, to Pasteur and to Salk, and to untold others whose research, whose attention to science, allowed the evolution to what we call modern medicine. And it's not just those oldies but goodies. Science and technology have exploded so rapidly and with such complexity that we would be hard-pressed to even begin to name the countless men and women who have lifted us up so we may practice medicine as we do today.

Think about the sonar researchers who gave us ultrasound. Think about the chemists and biochemists who gave us newer, better antibiotics and those who are now exploring antibody-directed therapies. Consider the engineers who design systems to make plastic into the life-saving tubes we place in airways or collapsed pleural spaces! Consider the dietary researchers who gave us TPN and the brilliant folks who designed radiation therapy machines, CT, and MRI! Stand in awe of those who laboriously invented machines to count cells and lab media to detect troponin levels, the products of blood clots, or hCG.

Nod in gratitude to those who designed, then crafted steel and titanium for fractures, those who created tiny coils and stents to be placed in small blood vessels. Be thankful for those who took their knowledge of the human brain and their compassion for human suffering and created the amazing pain medications we have today, so amazing that people will do almost anything to have them! As a man whose wife survived a massive saddle embolus, I'm eternally grateful to the folks who devoted years to developing thrombolytics and anticoagulants and to those who discovered how to make the chemotherapy agents she received for her cancer as well.

But let us not be rude. Consider all those who work in labs and factories, doing often dull and repetitive work in assembly and packaging to satisfy our need, our desire for drugs old and new, for needles and test tubes, for Foley catheters and Word catheters, for central lines, and the drills to place IO lines. And what about ultrasound? Those machines don't assemble themselves, and we certainly don't put them together, do we?

Wait, there's more! There are those in design and marketing. Those who sell and ship. Those who track supply and try to make production more efficient. There are untold numbers of men and women who give us the ability to ease pain and save lives.

I could go on and on, but you get the picture. What we do in modern emergency medicine is amazing and sometimes borders on the miraculous. We have every reason to be proud. But just as the college grad should honor the sacrifice her parents made for her, so we as clinicians must honor the gift, the effort, the brilliance, and the dedication of those who imagine, create, and produce the very stuff that makes our work more than a series of apologies and misery.

Hats off to all of you! Thanks for sharing your brilliance and dedication with those of us who can look our patients in the eye, and say, “I think we can fix this.”

Click and Connect! Access the links in EMN by reading this issue on our website or in our iPad app, both available on www.EM-News.com.

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FastLinks

* Find all of Dr. Leap's books at www.booklocker.com.

* Visit Dr. Leap's blog at www.edwinleap.com/blog and follow him @edwinleap.

* Read his past columns at http://bit.ly/LeapCollection.

* Comments about this article? Write to EMN at emn@lww.com.

© 2014 by Lippincott Williams & Wilkins

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