Friday, July 10, 2015

How should a chemist judge a physician?

I recently visited a physician (nothing serious, mind you, just one of those "I should probably go see a doctor sometime" sorts of feelings). I randomly chose a family physician; he seemed like a nice enough fellow, but honestly, I had no idea of his medical background or actual physician skills or anything like that. (Are physicians as dismissive of say, USMLE scores, as chemists tend to be of the chemistry GRE? How well do USMLE scores match, say, dead patients over a 25-year professional career?) 

Anyway, all of that "how do you judge one medical doctor versus another" reminded me of a favorite passage from a favorite novel (Neal Stephenson's Cryptonomicon) about the main character, Randy, and his search to find a good oral surgeon to remove some particularly impacted wisdom teeth:
It was at one of these parties where Randy overheard a dentist extolling some brilliant young oral surgeon who had just moved to the area. Randy had to bite his tongue not to start asking all kinds of questions about just what "brilliant" meant in an oral-surgery context—questions that were motivated solely by curiosity but that the dentist would be likely to take the wrong way. Among coders it was pretty obvious who was brilliant and who wasn’t, but how could you tell a brilliant oral surgeon apart from a merely excellent one? It gets you into deep epistemological [s--t.]* Each set of wisdom teeth could only be extracted once. You couldn’t have a hundred oral surgeons extract the same set of wisdom teeth and then compare the results scientifically. And yet it was obvious from watching the look on this dentist’s face that this one particular oral surgeon, this new guy, was brilliant. So later Randy sidled up to this dentist and allowed as how he might have a challenge—he might personally embody a challenge—that would put this ineffable quality of oral-surgery brilliance to some good use, and could he have the guy’s name please. 
A few days later he was talking to this oral surgeon, who was indeed young and conspicuously bright and had more in common with other brilliant people Randy had known—mostly hackers—than he did with other oral surgeons. He drove a pickup truck and kept fresh copies of TURING magazine in his waiting room. He had a beard, and a staff of nurses and other female acolytes who were all permanently aflutter over his brilliantness and followed him around steering him away from large obstacles and reminding him to eat lunch. This guy did not blanch when he saw Randy’s Mercato-roentgeno-gram on his light box. He actually lifted his chin up off his hand and stood a little straighter and spake not for several minutes. His head moved minutely every so often as he animadverted on a different corner of the coordinate plane, and admired the exquisitely grotesque situation of each tooth—its paleolithic heft and its long gnarled roots trailing off into parts of his head never charted by anatomists. 
When he finally turned to face Randy, he had this priestlike aura about him, a kind of holy ecstasy, a feeling of cosmic symmetry revealed, as if Randy’s jaw, and his brilliant oral-surgery brain, had been carved out by the architect of the Universe fifteen billion years ago specifically so that they could run into each other, here and now, in front of this light box. He did not say anything like, "Randy let me just show you how close the roots of this one tooth are to the bundle of nerves that distinguishes you from a marmoset," or "My schedule is incredibly full and I was thinking of going into the real estate business anyway," or "Just a second while I call my lawyer." He didn’t even say anything like, "Wow, those suckers are really in deep." The young brilliant oral surgeon just said, "Okay," stood there awkwardly for a few moments, and then walked out of the room in a display of social ineptness that totally cemented Randy’s faith in him. One of his minions eventually had Randy sign a legal disclaimer stipulating that it was perfectly all right if the oral surgeon decided to feed Randy’s entire body into a log chipper, but this, for once, seemed like just a formality and not the opening round in an inevitable Bleak House-like litigational saga.
My doctor wasn't particularly awkward, but I guess I don't need a brilliant physician yet. Maybe someday I will (and who knows, maybe he is actually brilliant.)

(You have to love how Stephenson picks brilliant people - they read TURING magazine and drive pickup trucks. I guess I'll wait for the doc who reads OPRD.)

*bowdlerized for corporate firewalls.

21 comments:

  1. The following are troubling signs:
    * "Crime Scene" tape across the office door.
    * Glass plate, razor blade, and straws on the desk.
    * Partners with a lawyer and/or funeral director.
    *Shows surprise when you are able to show up for your second appointment.

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  2. How they react when I say I'm a chemist. "I hated chemistry" is the absolute wrong response--it shows both a lack of bedside manner and the lack of faith in empiricism.

    Knowing that your PCP is just there to refer you to specialists when things get serious, really just go with personality. Mine is a NP, but 1) she liked orgo and 2) I don't want to punch her when she talks. Can't say that about all the MD's at that practice.

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    1. NP? Nice person? Natural philosopher? Nautical physicist?

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    2. Nurse Practitioner

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  3. With all the medical researchers who seem to care mostly about getting on TV, and irresponsibly hype preliminary results in a way that make non-scientists believe that a cure for cancer is just around the corner, or that some food item is a magical cure for everything, I have trouble respecting the field. I'd get tarred and feathered if I tried to publish a paper in JACS saying I invented invisibility spray or something like that!

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    1. Yep, never see any hype by chemists. Why, I have a hard time maneuvering around my home, what with it chock full of molecular electronics, organic solar cells, printed electronics items, and super high capacity batteries, not to mention all those items manufactured from CO2-based polymers.

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    2. Anon 9:20 here - Good point; I recall buckyballs were going to solve all of society's problems by the year 1998!

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  4. Well if I saw the majority of the students I taught when I walked into a Doctor's office, I'd probably turn around.

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    1. Amen, bro, as I recall the "I need an A--I'm going to medical school" dialog.

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  5. I don't know if my insurance provider would cover a sliding scale with difficulty, though.Of course, he probably shouldn't have to worry about that.

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  6. I always appreciate doctors who explain things thorougly. I had catheter ablation surgery for a heart arrhythmia last year, and the first thing my cardiac electrophysiologist did was get a chart out and start drawing and diagraming the electrical pathways of the heart, showing me how mine was messed up. That, some background research on him, and the fact that he does hundreds of these surgeries per year convinced me I was in good hands.

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    1. Holy crap, dude, glad you're all right.

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    2. Thanks! It was super weird to hear I had a heart arrhythmia (atrial fibrillation) as a healthy person in my early 30's, but its likely something I had for a long time and didn't know it until it got a lot worse. The whole saga may not be over yet, but I am doing great right now. I also know a lot more about heart physiology and anti-arrhythmic drugs than I ever imagined I would!

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  7. That's BRILLIANCE, not "brilliantness." I swear, the English language is headed down the crapper - it's all these people writing publicly without proofreaders.
    No one seems to understand the correct uses of complementary vs. complimentary anymore.
    The one that truly drives me mad - do you remember when "concerning" was a verb, and not commonly employed as an adjective? I do, and I wish we could go back.

    Now that I've got that out of my system, a brilliant oral surgeon is one who knows his spit.

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    1. I suspect the issue here is that Stephenson is writing in the voice of Randy (a character who is a massive computer nerd.) Perhaps Randy says "brilliantness"?

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    2. Why does it matter?

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    3. @ CJ - This could well be the case.

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    4. @ Anon 7/10 at 5:12 PM - Because it's a clear demonstration of lack of cultural continuity - a sign that the English language cannot have itself reinforced in common practice, which indicates that even more complicated (and important) aspects of English-language culture are slipping away.

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  8. @ Anon 7/11 at 2:40 pm - It's too late. Joyce's "Ulysses" opened that cultural circuit with parts of sentences like "Bronze by gold heard the hoofirons, steelyrining imperthnthn thnthnthn”. (From an NYT article. I haven't read the book.) Al Yankovic would have to turn "Word Crimes" into an opera to address this.

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    1. I don't know many people who have - which means that the damage has been largely contained to a subset of graduate and upper-level undergrad literature courses. Thank Christ!

      However, there's a distinction to be made between crafting neologisms and using linguistic phenomena in the service of art from a basis of high-level understanding of etymology (e.g. Dodgson, Joyce) versus degrading the commonly spoken language through willfully ignorant misuse. The context of the former is self-restricting. I don't, for example go about proclaiming how "the mome raths are outgrabing today," or saying "We'll knock off around brillig."

      Also, the former is employed in the enrichment of specificity of language - there are passages in Joyce where highly specific vocabulary - heretofore only "potentially" extant - is evolved from sound etymology. At this point I will issue a disclaimer - I am not a literature student; my experience with Joyce is mostly informed by an exercise from a hydrology class I took, where we took a several-page passage out of 'Ulysses' and tried to define all the hydrology-specific terms from it - probably some 60-odd words - most of which were neologisms but derived from words in actual use in an apparent search for greater specificity.

      The latter, however, spreads like a highly contagious disease, robbing the language of what precision it has and ultimately diminishing the wealth of vocabulary generally available by supplanting evolved vocabulary and turns of phrase with language that could just as easily be employed by a non-fluent foreigner or small child. Language should not be the dominion of the least common denominator. For those that hew to a utilitarian perspective (e.g. 'what does it matter?') I'd argue that lack of specificity can hamper communication. It would be a poor parallel to suggest that this might be akin to abandoning IUPAC but it does get at my point.

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  9. I once tried chatting to my neurologist about medicinal chemistry and I was thoroughly unimpressed. I am also not sure how to determine their brilliance, but surely a specialist about to proscribe some tryptans should know a thing or two about the difference between MOAs with reversible and covalent bond forming events.

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