Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, November 28, 2007
    Worry Beads

    Doctors sometimes acquire an odd assortment of tchotchkes in the course of their careers; conventions or drug reps are often a fruitful source for items which may or may not make practicing medicine easier, but at least will make you go "Huh?"

    My favorite of these oddball teaching aids has hung on V.'s office wall for years. It's a series of numbered wooden beads strung on a nylon rope; she got it at an endocrinology meeting. Graduated in size, the beads number from "3" (the smallest) to "20" (the largest).

    "What is this?" I asked the first time I saw it.

    "Testicles," she answered matter-of-factly.


    "You use them in testicular exams if you think the patient has hypogonadism." The numbers correspond to testicular volume - cubic centimeters or grams, she isn't sure. If you have an adult male with a 3, 4 or 5, you can be reasonably sure you're dealing with hypogonadism (meaning lack of testosterone/sexual development) because testicles are like breasts in that they enlarge in the presence of the appropriate hormone. Someone who does not have sufficient testosterone will have mini testes instead of the appropriate size.

    "What if the patient has a 20?" I asked. "Does that mean he has a problem?"

    "I don't think so," she leered at me.

    I weighed the string in my hands before hanging it back on the wall. "How often do you use this when you're checking a patient?" I queried.

    "Never," she shrugged. "I use them for worry beads."




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