Seeing Zebras

Anthony Rudine -- Well, it's a new year and a new semester. I just can't wait. I am extremely excited that this will be my last semester of actual classroom instruction, then I am on to my clinical years of treating and healing.

As is usual over the Christmas break, I had a round of checkups from my own physicians to make sure I was still hanging in there, and as usual, everything checked out fine.

Unfortunately, my family physician diagnosed me with a new disease this year – medicalstudentitis. I informed him that by learning about new diseases in medical school and learning of their symptoms, many of my friends and I had begun to diagnose ourselves with everything imaginable. He gave a quick chuckle and told me not to worry – what a great guy.

Medical school is an interesting beast. I'm sure you all have heard of the saying – 'when you hear hoofbeats, think horses, not zebras.' This is meant to say that the most obvious cause and the most simple explanation are usually correct. It is exceedingly unlikely that we, as medical students, will even encounter some of the rare diseases discussed during morning lecture.

My issue is this. How am I not to think I have a rare disease when the teaching is focused more on recognizing symptoms, of which many conditions share, and less on the statistical representation of the disease in society? How am I to separate the rare from the common, when much of my learning focuses on the rarities?

Let me elaborate. I live in Lubbock, Texas, a dry and windy place at any time of the year. A couple of months ago I started to itch. My first thought? Liver failure. Not dry skin from the dry and windy climate, but full blown liver failure. By the end of the day I figured I had hepatitis and was quite close to checking myself in to the hospital for further evaluation. Thank goodness I did not.

When I explained this to my family physician, he acted like he had seen the symptoms before -- medical students coming in (he is a professor at a medical school as well) to his office and describing to him why they had some rare disease because they had recently developed symptoms. He had seen it many times. Medicalstudentitis. And I had a severe case.

Another example. A good friend of mine in medical school showed up to class with a headache one fine morning. Unbeknownst to me, he had already diagnosed himself as well, and was seriously considering requesting an MRI of his head. His diagnosis? Brain tumor.

Here is the point. When am I to recognize that the rare diseases and conditions are actually rare? When can I distinguish the simple headache from the brain tumor? Certainly not now.

It is not, in my opinion, a question of knowledge – some symptoms are simply the same for many different conditions – it is a question of judgment. One must see so many presentations of the same problems to begin to notice abnormalities in the common versus the rare.

What took me some time to realize is that everyone has symptoms of many diseases. Additionally, I forget that I'm learning about the worst diseases possible while in school, and much more time is spent on the abnormal than the common and normal variations. So, it is only logical for me to conclude, based on that knowledge, that it is the worst case scenario – it is the only thing I know.

I'm just curious when this will change.