May 31, 2008

• Change of Thought

  While studying in borders today, I was struck by how my thought patterns have changed. It happened so gradually I didnt even notice it, but I feel like I have finally begun thinking like a doctor.

  Allow me to clarify. The first year of medical school my thought process was pretty much the same as it had been all through college. That is to say, data A leads to fact B in what was basically a memorization process. 2nd year, as you really begin to review pathology and organ systems, your entire neural network reconstructs from a linear memorization to a pattern recognition.

  An example:
  Year 1: bacteria==>sickness
  Year 2: streptococcus s a gram positive cocci, found in chains or pairs
  * causes Pharyngitis (strep throat), Cellulitis Impetigo, Scarlet Fever, and Pneumonia, among others
  * can not be prevented with a vaccine, but penicillin and macrolides will treat it
  * produces Pyrogenic Toxins that stimulate T cells
  * produces F proteins that facilitate adhesion to tissues, Capsules that prevent phagocytosis
  * produces streptolysins that destroy red and white blood cells
  * produces M protein that prevents complement activation

  but of course that is not how a patient presents to you. People come in with symptoms and it is up to the doctors to tease out clues like some kind of medical sherlock holmes and from there solve the mystery of the disease.

  To continue my example
  Year 3: sore throat…history of sneezing, coughing, fever…physical findings of inflamed tonsils…lab resutls rapid strep test positive with increased wbc count…most likely culprit…strep

  So while the beginning of my third year i had all this knowledge, I really had no clue of what to do with it. It was just taking up space. But now I have learned to seek the patterns within the presentation, and tie it back to knowledge that I sometimes didnt even know I had. My studying consists of reading through case files…where a classic presentation of some condition is given and you are asked the condition, the diagnostic test, and the next best step for therapy. And now, a lot of those cases seem simple.

  Dont get me wrong…real patients almost never present classically, as diseases dont read textbooks. BUt the point is I have finally learned the right kind of questions to ask the patient to tease out the clues i need to figure out a diagnosis. And once I have the clues…I actually have an idea of different treatments or tests that i need to further perform. And to me, that’s pretty amazing.

  It totally makes sense to me now why doctors call what they do “practice” It’s because while everyone continues to improve at this pattern recognition process, there is so much information out there that it can never really be perfected, but the longer you practice in any one area, the better you get and the fewer clues you need to figure out the next step, or the whodunit.

  To complete my detective analogy I began third year needing a smoking gun and bloody glove to figure out the murderer…now I have my forensics team and a single strand of hair may not be enough to solve the case, but it is enough for me to pin down the usual suspects.

  On an unrelated note…I probably wont be doing to many neuro stories as I have way to much to do right now…but the reason I dont care for neuro (coz grrsh asked) is that my attending for neuro manages to combine two of my biggest pet peeves in one person: she is disorganized/scatterbrained and a micromanager.

  I have reached a point in my training where i still need to be supervised, but not swaddled. Sitting in a room and watching the attending interview someone does not further my education in any way shape or form. I would much rather be told to go do something, and then evaluated on what was done right, wrong, or other techniques. But if you keep me idle, and keep me late in the hospital on top of it, well i get frustrated. And since neurology seems to be a whole lot of diagnosing the patient and not much else, well, it is not the field for me. I want to figure out what someone has and make an attempt to treat or control it, not tell a family, yup your father/sister/aunt/wife had a stroke in my expert opinion, and my work is done. Maybe it is different for other people but to me it appears that in neuro, you make the diagnosis, and then the patient is shit out of luck with the exception of a few cases. And that is not the experience i want out of medicine. I need to feel like i am making a difference, however pretentious it may seem.

  On another tangent, though an important one, I need to begin writing my personal statement for residency applications. As someone applying for an early match residency (which will be the subject of another post later) I really need to have my business all taken care of by mid july, august at the latest. That said, I will be posting several rough drafts of the personal statement here on the site for you, my loyal followers to peruse, and i strongly request as much feedback as you all can give me on it, because this is probably the most important essay of my career, and it needs to be well written and interesting, and I am hoping that you folks out there in internetland who come to my site do so because my general writing matches those criteria at least a little, and you can help me in improving it. And then you can all pat yourselves on the back for your part in helping me become a doctor ;-P

  • 10:33 pm
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