In the old days, we would see a patient, call the referring doctor, and discuss [the case] with them in a very pleasant way. Now, when you call a doctor, he’ll say to you, “Let me read your note,” and that’s the end of it. He doesn’t want to talk to you. Medicine has changed dramatically.
It used to be a very warm relationship between you and your patients. You looked at your patient, you studied their expressions, and now you look at the screen and very rarely look at the patient.
Question: Why do you still enjoy practicing medicine?
Dr. Tucker: The challenge, the excitement of patients, and now I’m doing a lot of teaching, and I do love that part, too.
I teach neurology to residents and medical students that rotate through. When I retired from the Cleveland Clinic, 2 months of retirement was too much for me, so I went back to St. Vincent. It’s a smaller hospital but still has good residents and good teaching.
Question: What lessons do you teach to your residents?
Dr. Tucker: I ask my residents and physicians to think through a problem before they look at the CAT scan and imaging studies. Think through it, then you’ll know what questions you want to ask specifically before you even examine the patient, know exactly what you are going to find.
The complete neurological examination, aside from taking the history and checking mental status, is 5 minutes. You have them walk, check for excessive finger tapping, have them touch their nose, check their reflexes, check their strength – it’s over. That doesn’t take much time if you know what you’re looking for.
Residents say to me all the time, “55-year-old man, CAT scan shows ...” I have to say to them: “Slow down. Let’s talk about this first.”
Question: What advice do you have for physicians and medical students?
Dr. Tucker: Take a very careful history. Know the course of the illness. Make sure you have a diagnosis in your head and, specifically for medical residents, ask questions. You have to be smarter than the patients are, you have to know what to ask.
If someone hits their head on their steering wheel, they don’t know that they’ve lost their sense of smell. You have to ask that specifically, hence, why you have to be smarter than they are. Take a careful history before you do imaging studies.
A version of this article first appeared on Medscape.com.