Reflections of an ID Specialist
Is there really a prototypical infectious disease (ID) physician? After all, our subspecialty societies boast thousands of members from all areas of the globe. I think some generalities can be made, however. As a group, we are different from other physicians in the following areas:
- We like nasty things. Come on, you know that it is true. We are always looking for pus, and we want to sample every bodily fluid, perform a biopsy on every organ, and debride every wound to get at it. Rust-colored sputum? Great! Necrotic gallbladder with purulent drainage? Even better, to smell that anaerobic fragrance!
- We know our geography. We are the only physicians constantly looking at maps that tell us where Ixodes dammini ticks are distributed or the endemic areas of malaria. Those of us who do travel medicine spend a fair amount of time looking up places such as Tierra del Fuego, the Galapagos Islands, and Ulan Bator. We are likely the only specialists who understand what "Hispaniola" means.
- We have a sense of romance and adventure. As a group, we like to travel, and many have been to very remote spots around the world. Some of us have studied new outbreaks of diseases in unusual places. We like to have new experiences and relate them to others. As an extreme example of this, a colleague with extensive experience in malaria failed to take his own malaria prophylaxis during a field trip to Africa and, much to his bemusement, contracted his own case of the disease. Not ruffled in the least, he proceeded to present himself as a case for grand rounds, complete with thick and thin smears of his own blood.
- We are linguists. What other group of specialists would take the time to learn how to pronounce Acinetobacter lwoffi, Pseudoallescheria boydii, or Stenotrophomonas maltophilia with such great relish? And then, not satisfied with the result, some of us have to go around renaming everything every once in a while, occasionally stirring up antipathy. Although the reclassification of Pluto as a nonplanet caused some strife, that was nothing compared with the coining of the term Pneumocystis jirovecii.
- We are humanists. We deal with spelunkers, bird fanciers, people who do not cook their meat, people who allow raccoons to defecate freely all over their property, people who partake of illicit substances in great quantity, and people with all manner of sexual practices. We understand that people are unique, and the human mind works in unexpected ways. We tend to observe rather than judge.
- We are philosophical. How could we not be when we know how many shades of gray there are and that nothing is absolute? We live in a world where antibiotics often help quell fever, yet in other instances cause fever. We have powerful antibiotics, yet have nothing to cure the common cold. We ponder unanswerable questions: is fever like Cordelia? Or like Regan and Goneril?1
- We are diplomatic. I have worked with a transplant surgeon who felt he could diagnose sepsis 15 feet away from the patient, without ever examining her. He also routinely placed patients with a single blood culture for coagulase-negative Staphylococcus on vancomycin and gentamicin. The ID team of this institution was, shall we say, constantly obliged to use its diplomatic balm.
- We are logical thinkers. We do not cut, we do not scrape, we do not intubate, and we do not insert prosthetic devices. What we do is think; thus, of all the clinicians, we are considered the eggheads. We are also asked to make order out of chaos. We wend our way through thick charts of illegible notes and try to make rational sense of it all. We construct a differential based on logic, order diagnostic tests based on logic, and choose antibiotics based on logic (until someone comes along and changes our orders).
- We are gourmands. We are aware of the charms and dangers of smoked Scandinavian salmon, chitterlings, walrus meat, vichyssoise, beef tartare, and a savory spinach salad with feta cheese.
- We are intellectually curious. The ID physicians delight in presenting cases to one another, enjoy writing serious articles, and often adore teaching house staff and students. Just look at the collective size of our journals, and you will feel the weight of our intellectual curiosity.
- We take responsibility seriously. When there is someone with pulmonary tuberculosis and acquired immune deficiency syndrome, who is first to see the patient? When there is an anthrax scare, who will come in on a Saturday night? Who is there making rounds on patient late at night, toiling alongside the night float intern? The ID physician, of course.
- This feeling of responsibility extends much further. Many ID practitioners are involved in world health. As a group, we worry about HIV in Africa, the availability of effective antimalarials, and getting the world prepared for avian flu.
- We are witty. Anyone attending our society meetings will attest to that. We lovingly give our talks names. I entitled a case of Kingella endocarditis "The Sovereign Remedy." A case of Rhodotorula rubra from a skin biopsy of a cancer patient was presented as "A Red Herring?" My mentor,
- Dr. Alan Cross, presented grand rounds on treatment of sepsis with cytokine blockade as "Waiting for Godot."
So, to paraphrase Adlai Stevenson, for all those pus-smelling, responsible, workaholic, witty, egghead ID practitioners, unite! We have nothing to lose but our yolks.2
1. Mackowiak PA. Fever: blessing or curse? A unifying hypothesis. Ann Intern Med
2. Baldwin O, Vochatzer C. Makers of American History
, 1st ed. New York: Noble and Noble; 1969:421.