The "A-Ha" Moments in Medicine

I wanted to jump ship and jump to a different topic than the last post by sharing what my colleague Dr Bell calls the "A-Ha Moment."  I use her words as they describe the feeling that really gets a physician excited.
  These moments are the few times in the day or month that a physician feels like he (or she) really helped someone.  Most of my "A-Ha" moments come from using osteopathic manipulation in the course of treating a patient. (Please keep in mind that being a good osteopath is more than just doing manipulation.  It involves the mindset and process behind the treatment.)

  I had one just this last week.  A lady came in in pain, with muscle spasms in her back and hips.  She had seen her doctor and was recommended to see me. I had just had two tough patients that were not getting better and was feeling a little down.  Listening to her problems, I came to believe I could help her!  In fact, I drew for her a diagram of her muscles in spasm according to what she had said and it matched exactly.  I was able to relax the muscles and she felt much better.  I walked out of the room doing a fist pump and feeling like I was a good osteopath again.

  My first true "A-Ha Moment" came while I was doing a family practice rotation in Pikeville, KY.  I was there to sneak all the learning I could from Dr Ed Stiles, and still see if I liked the program enough to apply there.  I was "shadowing" a resident (following him around like a shadow) when he got behind.  I was bored and quickly took him up on an offer to see one of his patients, while he finished off another.  The lady was there for the results of her thyroid test.
  I glanced at the chart (like a good ER doc) and hustled into the room.  Talking with her, I quickly found out that she had no energy and that her wedding ring wouldn't fit on her left hand because the hand was swollen for some reason.  Our conversation from there went something like this:
  "Ok," I said.  "Having a low thyroid level will make you feel pretty tired.  In addition, it also will make your hair feel course and thick, and also decrease your libido.  Does any of this seem familiar?"
  She stared at me like I was crazy and said, "You described me to the tee!"
  Feeling more confident, I did a quick physical examination and found her collar bone (clavicle) to be very restricted on the left, with her left 4th rib also posterior, or pushed back.  There was some bones in her neck stuck in rotation to the right, or away from the problem.  As such, I offered her my reasoning, again, paraphrased at follows.
  "If your thyroid is off and you are feeling lousy, that will not enhance an already low libido.  If your husband is typical of most men, then he will not be the most understanding of your decreased attention to him.  That stress, which affects your ribs here, combined with the dysfunction in your neck and collar bone, will all pinch down on the blood supply to your arm, blocking up the returning blood.  That is probably why your hand is swollen.
  "Now, if that is true, then let me fix this... and this... and this..." I fixed the problems in her collar bone, neck and ribs and stood back.  "I am willing to bet you, now, that your wedding ring will fit."  Indeed, her hand was visibly smaller than prior to treating her.  "Do you have any questions?"
  She shook her arm and rolled it around then looked me right in the eye and asked, "Where are you going to practice?"
  I walked out of there on air, told this to the bored resident and got her a prescription for some thyroid medication.  I am still willing to bet that she had a great response to that medication.  I couldn't follow up on her, due to heading out for another rotation, but I never will forget that feeling when she asked me where I was going to practice!  I felt like I succeeded!  That is an "A-Ha Moment."

  I hope all doctors have these moments scattered throughout their day.  It makes medicine so much fun!  They are fun to share and fun to remember.  It keeps me moving when the patients seem to be stuck on "whine" mode.  Best of all, it makes it fun to be here.