So, what characteristics define a particular worker?
Well, I can list a bunch. First, there’s a fund of knowledge. For example, an electrician needs to know a lot about electricity, circuits, grounding, etc.
Then, there’s an appropriate attitude. A laid-back, easy-going style is probably not ideal for an air traffic controller.
A set of responsibilities and corresponding prerogatives is a third characteristic. Take a border guard with the responsibility for an area and the right to patrol it, confront anyone in it, and arrest trespassers.
Two characteristics though, are among the most obvious: the clothing, uniform or things worn and the tools of the trade, the implements carried and used.
No one will mistake a chef with her hat, crisp white top and distinctive outfit. A firefighter in boots, turn out coat and helmet inspires confidence and a degree of awe. Football players all decked out aren’t going to be confused with Supreme Court judges in legal gowns.
The “stuff” involved in most jobs can be equally distinctive: plumbers with wrenches, drain augers and pipe cutting tools; landscapers with mowers, blowers, shovels and rakes; waiters with corkscrews, menus, pepper mills and those cool tablecloth sweepers.
I can’t remember anymore whether it was in the first year of med school, as we were still immersed in the basic sciences of anatomy, physiology, microbiology, biochemistry and similar foundational subjects, or in the beginning of the second year , as we started our first forays into clinical medicine with courses in physical examination, history taking and hands-on patient contact — but the day we bought our “doctor stuff” is a memory still as clear as a bell.
Vendors set up outside the lecture hall in the Wood Basic Science Building on Wolfe street at Johns Hopkins in East Baltimore and — like Hogwarts’s students shopping for wands, cauldrons and spell books — we crowded around examining all manner of black doctor’s bags, stethoscopes, ophthalmoscopes — those things doctors look into your eyes with — reflex hammers to pound on your knees with and all sorts of real-life doctor stuff; a little like being at Toys-R-Us shopping for Rowan’s first medical kit.
I still have all those things more than 40 years later. … The bag’s in the basement somewhere; they don’t make the rechargeable battery for the ophthalmoscope anymore; I’ve replaced the stethoscope with better ones as my career demanded; and the reflex hammer is someplace in a box of memorabilia.
A favorite game we would play over the rare sit-down lunches we’d have during med school was to try to figure out what rotation someone was on by what they were carrying and wearing.
Orthopedic residents were always in scrubs, stained with white plaster and carrying those big-handled, “can cut a penny” scissors in their pocket.
Neurologists were the only people who actually carried a black bag with super fancy reflex hammers sticking out of them and all sorts of testing equipment used to evaluate nerve functions.
Pediatricians had little koala bears or unicorns attached to their stethoscopes … but everybody carried a spiral bound book called “The Washington Manual.” This was the closest we had to Harry Potter’s spell book. Authored over generations by folks from Washington University School of Medicine in St. Louis, it was essentially the Cliff or Monarch Notes to basic medicine.
Drug doses, formulas, lists of alternative diagnoses, pictures of things not to miss, warnings, advice; it had all you usually needed to be safe and effective in our roles when you added to it the sage advice of a more senior person, available at the best training programs at almost any time — perhaps with some ribbing for needing the help, but always willingly provided.
Today, what are the most important implements for your health care provider? I’d say their computer or smart device and a phone — and access to the Internet and your electronic medical records.
There’s no reason today to trust your memory, guess or be unsure of an action. The best medical care today may be managed by a specific, responsible “captain of the ship,” but almost always depends on a group of other professionals, tied together electronically, all bringing their own expertise, skills and commitment to your care along with immediately available access to your records.
Over the next few months, I’ll tell you about some of the wonderful ways this connectedness helps us deliver the best care anywhere.
Dr. Alfred Casale, a Cardiothoracic Surgeon, is Associate Chief Medical Officer for the Geisinger Health System and Chair of the Geisinger Cardiac Institute. Readers may write to him via [email protected]