There are definitely times in my job in which I have the feeling, "I made a difference today." Then there are those time when I ask myself, "Could I be any more of a quack?" It may come as somewhat of a surprise that these "quack" moments generally center around writing a prescription, a very doctorly activity. Eighty five to ninety percent of cases of ear infections, sinus infections, pink eyes, and bronchitis are caused by viruses not at all amenable to antibiotics. I must admit due to patient expectations and wanting to just move on in my schedule at times I'll scribble for a little amoxicillin or azithromycin and say have a good day. (Most frequently these days I will try to use what's become known as the delayed prescribing strategy which at least introduces patients to the idea antibiotics aren't necessary and assuages my guilty conscience.)
One might think the hero moments involve delivering babies, completely excising an early melanoma, or aggressively treating a CHF exacerbation keeping someone out of the hospital. All pretty sexy stuff which does prompt me to pat myself on the back. However, these aren't the times in which I feel I've made the most difference in the lives of my patients.
A one month old baby I did deliver (and did pat myself on the back for since Mom was pre-eclamptic with a history of eclampsia with a prior pregnancy) came to see me today for a well child visit. At the start of the day we were fortunate enough to finally receive a precious 40 doses of the H1N1 vaccine to distribute amongst our 4,000 or so patients. While the baby was too young to immunize, his parents and two siblings are perfect candidates.
At first they were somewhat leery of the vaccine, but I've known them for five years, delivered two of their kids, seen them through some nasty RSV, and cared for the mother through periods of depression, so we have a history. I convinced them of the potential harms of influenza not only to them, but to this baby. They agreed giving these four people the H1N1 vaccine probably made the greatest difference of anything else I did all day long. Perhaps it will save this will only save this young family some time off work or an office visit, but it may also prevent a hospitalization, or even save one of their lives.