Medicine As Performance Art

Medicine is performance art. Make no mistake about it. When you walk into a patient’s room, you are on the stage. And you had better know your lines. We delude ourselves that this is all science. Oh, there’s science. But how much of what we do is entirely devoid of anything resembling science? How much do we do because the patient expects it? How much because it just makes us feel better?

In tribute to the performance art aspect of our scientific careers, I have a list of things accumulated through the years to help aspiring actors in their roles. By now, a number of new residency graduates have been in their jobs for a few months, and are wondering, ‘What did I get myself into?’ The answer is, ‘a huge mess.’ But that’s another topic. What I have to offer is a few guidelines for difficult situations. A few acting tips to get you through the tough nights and tough days of a difficult profession.

1) Reading glasses. If you don’t need them, some fake ones with a piece of regular glass or plastic might be useful. If you don’t know what the rash is, if you aren’t sure how deep the cut, if you can’t identify the tendon, pull out the old glasses and have a look. Your patients will be impressed with your attention to detail.

2) A lab coat. Now, I don’t really buy into this one, but some people think that a white lab-coat, freshly starched, is like a suit of armor against blood, pus, doubt and lawsuits. To each his own, I say. I stopped wearing mine in medical school, when all of the books and tools in the pockets began to hurt my shoulders, and made me believe I needed a breast reduction.

3) Have a pager, whether you need one or not. You don’t actually have to use it. But when the conversation turns from the patient’s current injury to his bunionectomy in 1968, which resulted from that insect-bite in Vietnam that followed the agent orange exposure and left him disabled for life, then jump as if surprised by a vibration, pull out the pager, look at its blank screen and murmur, ‘They just won’t leave me alone! Excuse me!’

4) Have a few catch phrases. My personal favorites are, ‘Let’s get you some pain medicine and order a few tests, so we can get to the bottom of this. Excuse me while I get things started.’ I also like ‘My kids all had the same thing, and they were just fine’. Another useful one is ‘I don’t know what’s going on here, but I think we may just need to talk to your doctor about admitting you to the hospital!’ (shows your interest and compassion and puts onus on primary care doctor). Some of these are also just exit strategies, to avoid protracted conversations with extended family. I know someone who always says, ‘We’ll get you bunked in for a day or two!’ and then effectively ends the conversation. It’s down home, it’s to the point and I have always admired it.

5) Look things up and tell people you’re going to. Invoke the Internet, which is, to the average person, much like consulting directly with the Almighty. ‘This could be an odd medication side-effect. Tell you what, let me go check it out on the Internet. I’ll be right back.’ They’ll recognize that you recognize your own limitations. If you don’t think it’s a real problem, look it up briefly and then check your web-mail, or see how your e-bay bid on Wilson, the volleyball from the movie ‘Castaway’, is going. This system will only back-fire in people who believe that books are a sign of weakness. They’ll say, ‘that doctor had to go look my problem up in a book!’ If they go elsewhere to find smart doctors who don’t use information developed after 1955, it’s no loss.

6) Do not show fear! You’re a doctor, so answer boldly, even if you’re uncertain. Here’s an example. ‘Doctor, before I go, I wanted to ask you, is it possible that the throbbing pain I get in my foot before bedtime is due to this mosquito bite?’ If you are new to the profession, this might frighten you. You’ll be thinking of Lyme’s Disease or other tick-born entities. You’ll be tempted to ask about foreign travel, and you’ll wonder about infectious arthritis and Malaria. STOP! The proper answer is as follows: ‘That’s interesting. I’ve never seen it, but I suppose it’s possible. Take some ibuprofen and benadryl, and come back if it isn’t any better.’ Say things like this with absolute confidence, but after a brief pause to look up and tap your temple with your index finger while spinning reading glasses in other hand. This is acting at its finest.

7) Some of my partners believe in the magical properties of the tendon hammer. If you take it out and pound on the tendons (assuming you can locate one beneath years of drive-through cheeseburger fat), you’ll again impress your patients with their own physiology, with your diligence and with your dedication to Marcus Welby medicine. If you carry one of the neurology versions, that look like one tire and axle of a Humvee, you’ll impress, but also be expected to explain complex neurological entities like ‘pseudo-seizures’. I advise you to use only the kind that looks like a little tomahawk. Also makes a handy weapon if assaulted.

8) The stethoscope! Take your time using it. Ask patients to breathe deeply, something most of them rarely do. After about 6 breaths, my patients usually say, ‘I feel funny, you know, dizzy-like!’ ‘That’s oxygen sir. It feels odd at first, but you’ll get used to it’. A revered physician I knew used to occasionally listen to our regular nuts with the stethoscope head, while the ear pieces rested serenely against the sides of his neck. No one ever knew the difference.

9) When families seem to think that you’re waffling, and when you may actually be waffling, meet with them in the room of their ill family member and say these words, ‘You know, these things require a delicate balance’. They’ll understand why you have neither admitted, discharged or transferred their loved one, and whey the nurses keep adding different IV medications when the last ones didn’t work.

10) A friend once suggested a ‘scream machine’ for the ED. When you are very busy, press the scream machine repeatedly, and when you walk into the room where the hangnail waited 3 hours, you can say, ‘I’m sorry it took so long, but I suppose you heard…well I can’t really say, but it’s been quite a night!’

These are just a few tips. In the course of many years, every physician develops a set of his or her own acting guidelines. By the time our careers are over, we’ll all deserve an Oscar.