I envision my work to aspire to be a cross between Hercule Poirot, Sherlock Holmes, and Sir William Osler. Most of my consultations involve people who have seen many other physicians who have not been able to put together the puzzle pieces to find an effective treatment or answer. Call me the fixer ( apologies to the author).
The consultation starts with the history, which in most instances provides 85% of the answer. The physical examination is done next to add data to the data pool provided by the history( the beginnings of this type of record go back to the 1960’s and the “problem oriented medical record.” ) The individual pieces of historical and physical data must be put together like the pieces of a large jig-saw puzzle. It is rare that all of the puzzle pieces are available at the first consultation , or even much later, but as a clinical physician, I have to develop a list of problems with possible causes and treatments so we can together start going toward a solution.
Many people have well described disorders such as Rheumatoid Arthritis, ands it is my duty to confirm the diagnosis, assess the severity , and provide information as to the types of treatments available ( I act as the waiter.) The premise of the treatment is that most people with this disorder, when treated early and aggressively will be put into a state of minimal disease if not complete remission, and will not have severe joint damage nor will they be disabled. With this disorder, multiple medications are usually necessary and the patient needs to understand the benefits, side effects and costs of the treatments.