These e-books (and later website) are the culmination, convergence and combination of several ideas and observations over several years. All Family Physicians, through their years of practice, develop certain shortcuts in procedures or diagnoses, specific observations about patient care, and various routine practices. They learn from their patients, from other physicians, and by “trial and error”. All combined, these “tricks of the trade” are used so commonly in everyday practice that they become routine in that physician’s practice. That physician may assume that everyone else knows about these “tricks” and may well forget where or when they learned them. The majority of these pearls never find their way into the medical literature and cannot be deemed a product of evidence-based research. However, they work well for that physician and his or her patients.
I noted the behavior of my partners when I would utilize one of my own “tricks of the trade”. When I was on call, many times I would use a learned “trick” with a partner’s patient. When my partner would read my written account of the patient encounter or hear a verbal report from that patient, he or she would question me about that specific practice. I had always assumed that everyone knew the “tricks of the trade” that I knew and used, and that they were commonly taught in training programs. This turned out to be false. My partners were delighted to have these “tricks” shared with them so they could use them in their everyday practices.
I also noticed that some of our very best community preceptors and many of my mentors were retiring. With these retirements, an amazing amount of wisdom was no longer being shared with young learners and was being lost. These “tricks” or pearls would have to be re-invented by other physicians. At the same time that I was noticing these trends, I was searching for a way to “give back” to the specialty of Family Medicine and to help younger family physicians and learners. All of these thoughts and observations were mulling around in my subconscious while I was attempting to develop a theme and project for a sabbatical. Coincidentally, in this same time period, I took my family on a vacation trip to northern California. During a trip to Muir Woods, I had the opportunity to commune with the Giant Redwoods while the rest of my family took a long hike. As I sat alone in a grove of ancient Redwoods, I challenged the trees to “inspire me”. I imagined that they could truly impart “wisdom of the ages” since these trees had existed for centuries.
A thought immediately struck me – Wisdom of the AGEDS. I could interview experienced Family Physicians from all areas of the United States and record their wisdom and “tricks of the trade” they had learned through their years of practice. I could then pass those clinical pearls on to younger physicians so that they would not have to reinvent or rediscover techniques that work. This could be my way of “giving back” to the next generation of family doctors and would be a wonderful sabbatical experience. The trees had given me my sabbatical idea in less than 5 minutes! Then I had almost two hours to wait for my family to return and nothing to do but admire the trees. It was wonderful.
-Rick Ricer, MD 2003