Quincy, M.E. – a homage

This is a re-written version of a blogpost that I put up on northerndoctor.com back in 2008. The death of Jack Klugman seems an appropriate time to post a small tribute.

Kick back and enjoy the classic opening theme for a minute. It’s a proper little earworm – I’ll be humming it for days now. Doo doo-doodoo doo dooo!

One of my resolutions when teaching medical students is to stop making cultural references that are likely to be met with blank looks.  Partly because it baffles the students – most of them were not born when Quincy was in his pomp – but mainly because it is mildly depressing for me.

Quincy, M.E. is the reason I am a doctor.

With no doctors in my family, and in the pre-internet universe (how did we cope?), my view of the medical profession was limited to 1980s television. That really didn’t extend much beyond Quincy, early Casualty and that programme, Doctors to Be, that followed some St Mary’s medical students through their course. That really was it. Exposure to Quincy at such an impressionable age meant that I initially assumed I would go on to be a forensic pathologist. The postmortem scenes may look tepid by today’s maggot-ridden standards but at the time they were thrillingly morbid. However, when I arrived at medical school in 1992 I was very quickly disillusioned after about 5 minutes into our first histology lesson. Squinting down microscopes at pinkish-purplish blobs with my defective colour vision meant pathology quickly lost any glamorous associations with Quincy.

Klugman was magnificent as the character and Quincy remains a great, albeit fictional, role model. He was phenomenally tenacious with exemplary clinical skills. Most importantly, he had a moral compass second to none. All of this was allied to an ability to sniff out a corporate murder from the other side of the county. He was also a bit of a one for the ladies and he enjoyed a good rant at stifling bureaucracy. What a legend.

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Professionalism – turning dolphins into whales

Professionalism – turning dolphins into whales by northerndoctor

Posted on Sunday, June 20, 2010 at northerndoctor.com

Professionalism is an explicit outcome in most medical curricula yet remains a nebulous concept. Some medical students recently asked for my opinion on body piercing and tattoos. Would having a tongue piercing or a tattoo constitute an unprofessional act?

The many systems being developed to assess and measure professionalism can feel oppressive. Paradoxically, patients thrive on the traits of a doctor they come to know over many years. My hairdresser can give me a detailed rundown of the personal flaws of the doctors at her practice. Their eccentricities are well documented and they may well struggle to ‘pass’ a modern test of professionalism but a stable primary care system allows patients to drift toward the GP that matches their own foibles. It’s worrying that early exposure to some consultation models and the systematic medical history homogenises students. It would hardly be surprising if they felt coerced, pressurised to conform and nervous of expressing their own individualism. We all have to find a way of feeling comfortable in our own skin when we practice medicine.

And what is the prevalence of body piercing? Rather helpfully, there was a study in the BMJ in June 2008 which set out the prevalence of non-ear lobe piercing.

Adults aged 16-24 had a prevalence of 27.4% (95% CI 24.8 to 30.0) for any kind of piercing. The most common were navel (14.8%), tongue (6.5%) and nose (6.1%). A proportion of over 1 in 4 with a piercing suggests to me that it is normal behaviour for some young people.

Of course, there is a downside to tattoos that goes beyond the potential to cause a fit of the vapours in venerable consultants. Blood-borne viruses aside there is little to guarantee that the subtle, philosophical motif that elegantly symbolises your personal credo will be so appropriate in ten years time. How about fifty years hence when you are drawing your pension? They are a highly visible sign of the ageing process and the clear lines of youth are remorselessly smeared out into the blurry edges of old age.

One of the answers to professionalism, at least in primary care, may be to concentrate less on the individual and to spend more time ensuring continuity in the system. Fragmentation of care may ultimately make people less tolerant of normal human eccentricities in their doctors.

My final word of caution would be for the female students: before you get a dolphin tattooed on your abdomen, spare a moment to consider the effects of the gravid uterus on your body art. As one young pregnant woman bewailed: “Look at my tattoo; it’s not a dolphin, it’s a bleeding whale!”

Bone, A., Ncube, F., Nichols, T., & Noah, N. (2008). Body piercing in England: a survey of piercing at sites other than earlobe BMJ, 336 (7658), 1426-1428 DOI: 10.1136/bmj.39580.497176.25

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