COMPASSION WITH A SIDE OF CORNBREAD AND PINTO BEANS
Probably like many physicians, I an not certain how I ultimately chose medicine as a career. At one time I wanted to be a CanadianMounted Policeman, and met the requirements, except for the part about needing to be Canadian. I doubted I would ever be offered one of the good roles on "The Bold and the Beautiful." My artistic talent was limited. And when your score on the Wonderlic test exceeds the distance that you can actually throw a football, NFL quarterback is out.
As a medical student, I found the biology of the kidney intellectually attractive. It has a spatial architecture and grand design that rivals the brain. It can instantly and precisely alter chemicals in our blood and respond to changes in our diet and environment. It plays a significant role in blood pressure, the production of red blood cells, and the mineralization of our bones. It allowed us towalk out of the ocean and begin our evolution on land. Virtually all diseases affect the kidney and kidney disease impacts all other systems in the body. A nephrologist is at once a generalist and a specialist.
Diseases of the brain are the "last frontier," but diseases of the kidney are a microcosm of our current health care crisis: we do a better job at and spend more money on treatment than prevention. The great majority of patients with kidney disease have diabetes and hypertension. At a time when diagnostic technology is advancing rapidly, when we are deciphering the human genome, when more precise pharmaceuticals are being developed, we still fail to identify and adequately treat the number of people with diabetes and hypertension that we should. And yet, having failed to prevent the development of renal failure, when these patients ultimately come to needing dialysis, we can sustain them for many years.
It's curious that physicians are said to "practice medicine."We understand what it means to practice a musical instrument, painting or foul shots: through repetition and error, we become better. In each of these, errors are not particularly important until they flaw a performance, ruin a canvas or alter the result of a game. While physicians train for years as students, interns, residents and fellows, the opportunity to make errors without consequence is rare, and so we do not practice in the everyday sense of the word. continued ...