By Steve Lewis
MADISON, WI — Tim Cordes, MD, a psychiatrist at the William S. Middleton VA Hospital in Madison, WI, may be legally blind, but his insight into his patients’ needs is considered extraordinary.
“He’s very calm,” said Dean Krahn, MD, chief of psychiatry at the Madison VA. “Given that he can’t see, I think that he’s more attentive to everything you say. He picks up on a lot; he listens closely for the sound of your breathing, the tone of your voice. … He senses a lot about the patient and has a unique way of picking up on things other doctors might miss.”
Being legally blind would seem to present unique challenges for a medical student, but Cordes told U.S. Medicine that he has found ways to overcome them.
“There were actually two kinds of challenges, real and technical — like how to work in a visual environment,” he recalls. “I used technology whenever I could — for example, an Opticon device which converts a postage-stamp-sized field of view of an image to vibrating pins I can feel. I could use that to look at EKGs, and X-rays to some degree. I used computers whenever I could and EMR (electronic medical records) when they came online.” Cordes notes that he had been using keyboards since he was 8 years old.
When it came to physical exams, he explains, a sighted physician watches people move their arms and legs, “So I place my hands on their arms and legs” to obtain the same types of information. The key to his success, he declares, has been to “just be consistent and work hard and do my best.”
Drawn to VA
Cordes says he developed an interest in science long before he determined that he wanted to be a physician. “Then I realized I wanted to do something more personal or human, and medicine seemed like the place to do that,” he recounts.
His clerkship experience in medical school at a VA facility “got me to thinking about” working at such a facility. “I worked with some really neat patients in an inpatient rotation; I saw them come to the hospital, get better and leave — so it was a great experience,” he says. “Ironically, one of those patients I saw as a medical student in 2003 I am now caring for as his primary psychiatrist.”
In addition, Cordes says, “I really like my co-workers and the patient population. And the EMR is really accessible with the speech software I use.”
How does he respond to observations that he brings something unique to his patient care?
“I think I’m just differently tuned — I’m not sure if I’m more tuned,” Cordes insists. “I pick up on different cues patients are sending and put their story together in different way. I can listen to their gait — how they walk down the hall — clues on what they wear or where they gaze from the sounds they make. In other words, I get a lot of what other people consider ‘visual’ information through other channels. Breathing absolutely provides clues on emotions, and hands — whether they are steady or playing with papers, for example — also provide clues.”
Asked what he finds most rewarding about the practice of psychiatry, Cordes responds, Working with people and with their individual stories. After a while, with whatever you do in most areas of medicine, things become the same. But in psychiatry there is always a unique story, a specific set of circumstances they work through, and that’s what I like about it.”
In addition to his love of psychiatry, Cordes says he draws special satisfaction from working with veterans. “I like working with this patient population,” he notes. “It’s hard to describe; we lump them together and we call them ‘vets,’ but I see guys from the age of 80 down to 20, with all different kinds of life experiences.”
Although his patients have one thing in common — their military service — each individual is unique and totally distinguished from the general population, Cordes maintains.
“They have had to work, function and perform at levels a lot of people in the general population never had to,” he explains. “Sometimes you can draw from that when you work with them; both you and they know they can be capable of doing more than think they are.”
As for the future, Cordes suggests, his main goal is “To be the best clinician I can be.” He also wants to pass on what he knows to the residents he teaches.
Cordes says he has put his resume on the White House’s job site “to see if there are other ways I can be serving, but I definitely like what I’m doing right now.”
The nominee for new VA secretary has served as the White House physician for the last three presidential administrations.
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