Consult Guys

As a practicing physician, I understand the temptation to skip the medical literature. A sick patient comes in and we're so focused on the things that might help him, as what we'd been taught in medical school, that we don't think of looking at anything else. Except those maxims portrayed as the golden rule by our senior.

The sicker the patient, the greater the temptation to skip the reality check. It's a temptation that can sometimes prove wrong. My classmate's dad came in two weeks ago with crushing chest pain. In the middle of the night. I was on call and told myself that was a serious heart attack after looking at those berserk zigzag lines of his electrocardiogram. And a heart rate slower than 40 per minute. This means a blocked blood vessel depriving my patient's heart muscle of oxygen supply. One of the most dreadful consequences of deoxygenated heart muscle is muscle death, if not patient's death.

Quick, I reminded myself, to bring back oxygen to his precarious heart by clot buster medication. And extra oxygen, most of us would say. Why not? President Eisenhower was even placed in an oxygen tank when he had an heart attack more than sixty years ago. We don't use oxygen tank nowadays; my previous textbook Clinical Medicine by Kumar and Clark suggested oxygen at 60% administered by face mask for several hours. This is not a new idea. And neither is it a correct idea. With time, we are learning the harmful effect of (too much) oxygen. This is a recent topic in the journal Annals of Internal Medicine . The title of this video teaching feature is Consult Guys, by which it refers to two old guys (think about the white-haired consultant in authoritative white coats) discussing the updated science of medicine.

The way those two consultants address the questions and debunk those because-I-said-so myths can powerfully remind myself not to let my brain get sclerotic with age, sticking with dogma without doubt. Even my hair isn't getting grey, I am old enough to get a job promotion to be the consult guy. That's why I have to read and keep myself updated.