The Differential: Medscape Med Students Blogs

What Do I Want To Be When I Grow Up?

Kendra Campbell -- I’ve recently been thinking a lot about what I would have done with my life had I not gone to medical school. So, I was inspired by Colin's post to make a short list of what I “could” have become:

1. An Artist: I’m not sure exactly what type of art I would pursue. However, given my inclination for incorporating the viewer into the art itself, I think I’d probably lean towards some type of performance/street art.

2. A Veterinarian: If you’ve read many of my posts here on The Differential, you probably saw this one coming. I’m an animal maniac. I can easily see myself in 20 years living on a ranch somewhere with hundreds of animals running around inside and outside my house. It seems that it would have made good sense for me to choose animals over humans!

3. A Musician: Unfortunately, this one exists as a possibility only in my mind. Although I am incredibly passionate about music, and think I have the heart and performance abilities to put on a good show, I am completely and utterly lacking in talent. I can’t sing or play a single instrument with any level of skill.

I could continue the list for pages, but I shall not. Since I am in my third year of med school, and I have a monumental level of debt hovering over me, my dreams of pursuing other fields have been all but extinguished. Now, I have a new decision in front of me. Which specialty should I pursue?

Some students know from the time they are 5 years old that they want to be a pediatrician or a surgeon. But there are many of us who really don’t have a clue. The third- and fourth-year clinical rotations are intended to expose us to the various specialties, and they do, in fact, help most students narrow down their choice.

There are also numerous quizzes, tests, and scales that students can use to help them decide which specialty fits them best. Here are just a few:

1. The AAMC’s Careers in Medicine website

2. The University of Virginia’s Medical Specialty Aptitude Test (MSAT)

3. Test of Attractiveness of Medical Specialty by Temperament via Myers Longitudinal Study

Of course, if all else fails, you can use this very technical flow chart to figure out which specialty fits you best.

I am currently leaning strongly towards either emergency medicine or psychiatry. My MSAT results revealed emergency medicine as my best match, and psychiatry as my worst. The highly technical flow chart was actually great for narrowing my choices down as well. I am definitely crazy, so it confirms my hunch that emergency medicine and psychiatry are best for me!

I think what it really comes down to is letting your gut decide. Of course, that’s way easier said than done. Perhaps some of us never really decide what we want to be when we grow up!

Tell Me What You Want!

Kendra Campbell -- I’ve been contemplating writing this blog post for a few days now. I wanted to write it, but thought I should wait until I had calmed down a bit, so that it didn’t sound like a huge ranting session. I guess I might as well just tell the story. I think it might help release some of the stress.

Let me begin with some background. I have no idea how to say this without sounding conceited, so I’ll just say it anyway. Echoing the thoughts of Jeff Wonoprabowo in his recent post, I have also always struggled to be the best. I have always maintained a very high GPA. I have always excelled in my exams. I am a bit of a perfectionist. I am a natural leader, and I always try to do everything to the best of my ability. I am generally not lazy, and I am good at “getting things done.” Okay, I hope I don’t sound too full of myself. I am certainly “not good” at many things (singing is an excellent example), but there are some things that I’m really good at, and making good grades has always been one of those things (as is common with most med students).

I did very well during the basic science years of medical school. I maintained a high GPA and performed well on both written and oral exams. I also did very well during my first two clinical rotations. My third and fourth clinical rotations, however, have been a bit different.

Okay, so now I’m going to come right out and say what I’ve been beating around the bush about. I received a “B” in my surgery rotation. Now, I know there are probably many people out there who are thinking, “seriously, SERIOUSLY, she’s complaining about getting a 'B?!' What’s wrong with this girl?!” But I’m hoping that many of you are still reading, and maybe there are even a few of you out there thinking, “hey, I understand!”

Here’s the thing. My surgery rotation was very tough. The hours were grueling, and the work was at times quite challenging. But I rose to the challenges. I stayed late when no one else would. I offered to do consults and other non-required tasks. I scrubbed in when no one else wanted to. I went out of my way to help my patients. I spent more time with them then I had to. I got along well with “most” of the nurses, residents, and attendings. I always did what my residents asked of me, and tried to always go above and beyond their expectations. I also did comparatively well on all the exams and quizzes. I can honestly say that I think I deserved an “A.”

I think the main problem with the surgery rotation was that we were never really told how we were being evaluated. Unlike my first two rotations, which provided clear guidelines on how students were graded, we were basically in the dark. When I got my grade, I didn’t even know who actually gave it to me. I also don’t know what I could have done better to earn an “A.” I certainly can’t think of anything shy of actually performing the surgeries myself.

Unfortunately, my current internal medicine rotation seems to be going similarly. I don’t really feel like I know what is expected of me. And this time, I really don’t know if I’m even doing a good job because I’m not sure what a good job is!

So, that’s my rant. I know it seems like such a silly thing to be upset about, but I just don’t like the feeling of “not knowing,” I guess.

I’m wondering if this lack of information about expectations has to do with the hospital, or the rotations, or the attendings, or something else. I’m actually very interested to know if anyone out there has experienced anything similar. Do you always know how you’re being graded during your clinical rotations? Or have any of you also experienced what I’m going through? Also, have you ever received a grade on a rotation that you thought was not a true reflection of your performance?

The Difference Between a Doctor and a Nurse

Kendra Campbell -- While rounding today, I auscultated a patient’s heart and then reported my findings to the resident. Luckily, I was correct in my diagnosis of aortic stenosis, based on the murmur I heard. My resident applauded my findings and then said something which offended me a little bit. He said, "see, now that’s the difference between a doctor and a nurse... You were able to diagnose aortic stenosis based on a clinical finding. A nurse would have to read the echocardiogram report to make the diagnosis." While I know that he was trying to give me a compliment, I felt that he was doing so at the expense of criticizing nurses.

Today was not the first time I heard a physician utter the phrase, "that’s the difference between a doctor and a nurse." Actually, I’ve heard many doctors use the phrase to demonstrate the ways in which doctors are superior to nurses. I’m sure sometimes doctors use the statement to simply point out the differences between doctors and nurses, but I happen to feel that the words are a bit diminutive towards nurses.

I’ve never worked as a nurse, but I did work as a technician for over three years and was a part of the nursing team. While I didn't have as many duties and responsibilities as the nurses, I did take vitals and performed other nursing types of procedures. Because of this experience, I have a good idea of what nurses go through every day. I’ve been on that side of the equation.

Now that I am a physician in training, I am on the other side of the equation. I see everything from the doctor’s perspective, and the nurses are now the ones that I ask to do things, instead of the other way around.

The conflict between doctors and nurses has been around since the beginning of both professions. Most physicians would agree that nurses can be your best friend or your worst enemy, and it’s hence a good idea to stay on their good sides. However, I’ve seen a lot of variation in the ability of physicians to interact with nurses positively.

Having been on the nursing side, I feel like I’m more hyperaware of the importance of maintaining an excellent working relationship with the nurses (and for that matter, every other member of the clinical team). I also realize that condescension and superiority complexes can lead you into precarious waters with the nurses.

Ultimately, our patients are what matter the most, and we should all be able to put aside our differences in order to provide them with the best care possible. I think it’s important to recognize and appreciate the unique contributions that each member of the team makes. I’ve seen some physicians who are quite skilled at working well with the other team members, but I’ve also seen ones who have a touch of the god complex, and can’t seem to come down from their high horse for long enough to appreciate the work of the techs and nurses, in particular.

Perhaps it would be easier if we all walked a mile in each other’s shoes. If every doctor had to spend at least a few days working as a nurse and vice versa, maybe there would be a lot more respect for each other’s jobs, and for the so-called "differences."

I Have Insurance But No Doctor!

Kendra Campbell -- As I alluded to in my recent post, I have a health insurance plan provided by my medical school, but have been unable to find a primary care physician. It seems that whenever I make calls to find one, they are either not accepting new patients, or the first available appointment is so far into the future that I can’t even guarantee that I’ll be able to make it. I live in New York City, so can you imagine what it would be like if I lived in a small town somewhere in rural America?

The unfortunate consequence of this situation became even more real to me a few weeks ago when I became sick and needed to see a doctor. Since I was unable to locate one, I ended up going to the Emergency Department of the hospital where I’m currently rotating. You can imagine how silly I felt sitting in the waiting room for many hours, clogging up the system, wasting the doctor’s time, when all I really needed was for someone to take a quick listen to my lungs, check out my throat, and write me a prescription for some antibiotics.

At least I was lucky enough to have access to a doctor at all. Not everyone is always this lucky. So many people out there don’t even have health insurance at all. What is going on?!

I’m sure most of the readers of this blog already have a good idea of how broken the U.S. healthcare system is. I could rant for many hours on this topic. However, I’m just going to focus on one specific part of the problem right now.

A survey of physicians recently published by the Physicians' Foundation found that:

- 78% believe there is a shortage of primary care doctors in the U.S.

- 49% said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely

- 94% said the time they devote to non-clinical paperwork in the last three years has increased, and 63% said that paperwork has caused them to spend less time per patient

- 82% said their practices would be “unsustainable” if proposed cuts to Medicare reimbursements were made

- 60% would not recommend medicine as a career to young people

Now, the results of this study must be taken with a grain of salt, as there was only a 4% response rate, and there is obviously some self-selection bias at play. However, I don’t think anyone would disagree that “the proof is in the pudding.” I was unable to find a primary care physician in New York City, one of the largest cities in America, in a reasonable amount of time. There is something seriously wrong with the system, and with the future of primary care in this country.

I encourage you to read some of the actual responses from physicians at the end of the report. It was pretty eye opening for me, and it might just make you want to get out of your chair, go to the window, and scream, “I'm mad as hell and I'm not gonna take this anymore!”

I found this response to be particularly saddening:

“I put everything I have into treating my patients. I’m about to lose my family for nothing. Just because I try to take good care of my patients – but it’s just too much work and nothing in return. My children have suffered because of time without their dad.”

What are we to do?

A Taste of My Own Medicine

Kendra Campbell -- I’m sitting in my bed in my apartment in Brooklyn, New York. I am wearing comfy sweatpants and have my blanket pulled up as high as it will go while still allowing me to type. I have two pieces of toilet paper, crumpled up, stuffed in each nostril, soaking up copious amounts of mucus. The heat in my apartment is turned up to the max. My bedside table is littered with cough syrup, nose spray, ibuprofen, tissues, water, orange juice, chapstick, day time cold meds, vitamins, and honey. Every few moments, I have to stop typing to cough up some mucus into a tissue, or to change the “snot plugs” in my nose.

You might have guessed by now...I am sick.

What started out as a minor cold eventually turned into bronchitis, and I somehow then developed pneumonia. Life definitely sucks right now.

Yesterday was quite an interesting day. I came into the hospital at 8:00 a.m. for morning rounds. My attending physician took one look at me and told me to go home and to get checked out by a doctor. Since I have no primary care physician in New York, and since I didn’t feel like calling around to various doctors, only to be told that they weren’t accepting new patients, and since my health insurance is so crappy that I knew I’d be paying out of pocket anyway, I decided to take the elevator down to the Emergency Department of the hospital.

Now, at this point, I was still wearing my white coat and stethoscope, and when I approached the ED check-in counter, the friendly nurse immediately said, “how can I help you doctor?” When I told him that I needed to see a doctor, he promptly recorded my details and alerted the triage nurse to come take my vitals. Since I had to take off my white coat to have my blood pressure taken, I went ahead and left it off the rest of the time. Now, I was no longer a med student/fake doctor, but had joined the ranks of the patients.

After getting my vitals, the triage nurse handed me a cup and told me to get a urine sample and bring it back. All of the ED bathrooms were occupied, so I walked down the hallway to find an available bathroom. The only one I could find had a broken lock, but I decided to use it anyway. Halfway into giving my “sample” an elderly hispanic man opened the door, was surprised to see me hovering over the toilet with a plastic cup between my legs, mumbled something in Spanish, and then promptly closed the door. Yes, I was definitely now a patient.

I returned to the nurse, gave her my urine sample, and sat back down in the ED waiting area. Many hours went by, and many of my fellow med student friends came by to check on me, and upon realizing how long I’d been waiting, suggested that I use my med student status to get bumped up in line. They had apparently done this many times before. I thought about it, and decided that I didn’t want to. My visit really wasn’t an emergency, and I didn’t think it was fair to go ahead of all the other people who had been waiting just as long. It eventually became obvious to me that had I kept my white coat on, I would have received different and mostly likely faster service.

If I had to do it all over again, I would do it the same way. I kind of liked the anonymity of being just another patient, and not a medical student wearing a stethoscope. In fact, I think the only way anyone could tell that I was not an average patient was by the color of my skin (most of our patients are latino/hispanic or black) and by how I described my symptoms.

In fact, I think the doctor who eventually saw me thought it was a bit entertaining that instead of listing my symptoms as a runny nose, watery eyes and coughing up blood, I complained of rhinorrhea, excessive lacrimation, and hemoptysis.

Ahhh, the joys of being a patient! Now please excuse me while I change my snot plugs.

I Wanna Hold Your Hand

Kendra Campbell -- A few weeks ago, I had an experience that has really stuck in my head. The resident and I were performing a painful procedure on a patient, and I could tell that he was really enduring a lot of pain by the grimace on his face. As I’ve done in the past, I instinctively reached out my hand and held his hand in mine. I allowed him to grip my fingers, and told him to squeeze my hand as hard as he needed to.

He started squeezing my fingers, and suddenly his face turned from a grimace to a smile. The change was rather startling, and so I jokingly told him that I’d never seen a patient with such a huge grin on their face while undergoing such a painful procedure. He smiled even more and said that it was because he was so happy to hold such a “pretty girl’s” hand. I smiled back, and soon the procedure was over.

I think it probably makes common sense that hand holding might bring some relief from pain. We all reflexively hold a child’s hand when they’re in pain. And I believe that even the most callous people might agree that there is something powerful about the human touch. Hugs are an even better example. I don’t know when the hug was invented, but I’m sure that it’s been around for quite some time. People of all races, ethnicities, and cultures seem to use the hug as a means of displaying affection. And while certain cultures might value human touch to varying degrees, I think we all agree on its significance.

One of the most well known studies on the power of touch and the importance of physical and social interaction is that of Harry Harlow. In his famous experiments, he allowed rhesus monkeys to choose either a cloth or wire ”surrogate mother,” both with and without a bottle of milk attached. Regardless of which mother had the bottle, the monkeys continued to choose the softer, cloth mothers. He also performed other controversial experiments, including ones where he deprived the monkeys of all physical or social interaction. The lack of physical touch produced monkeys with severe psychological pathologies, and in a few cases led to their deaths from self-induced starvation.

A study recently published in the journal Science also found some interesting results with regard to “warm hands and a warm heart.” The researchers found that if people were given something warm to hold, they subsequently described other people as having “warmer” personality traits, such as being more generous, more social, happier, and better natured. They also discovered that people who held something warm were more likely to behave in a friendly and generous way.

I’ve only begun to scratch the surface of the importance of the human touch, but you can see that the subject is much more than simply skin deep (pun intended). I tried to find some research that supports my anecdotal notion that holding someone’s hand who is in pain can serve to decrease their perception of the pain, but I was unable to find much research on this topic. Perhaps it’s a topic that will be further explored in the future.

But for the time being, I will continue to hold my patients’ hands. Whether they are in pain, or just very sad, or just very lonely, or even just very happy, I will continue to offer my hands to them. And hopefully when I need a hand to hold, someone will do the same for me.

When Burnout Leads to Suicide

Kendra Campbell -- A few months ago, I received a phone call that I’ll never forget. An obviously distressed friend and fellow med student was on the line. In between the sounds of sobbing, she related to me the most unbelievable truth. Another friend and fellow medical student was dead. He had committed suicide the night before. I nearly dropped my phone. I was, of course, in complete shock and didn’t understand what was happening. Time has passed since then, but the shock has still not faded. I can’t believe he’s gone.

Unfortunately, my experience is not all that unique. Many studies have documented the fact that medical students have higher rates of suicide than that of the general population. And guess what profession has the highest rate of suicide? You guessed it, physicians.

We have known for many years that medical students and physicians have higher rates of suicide. Studies have shown that psychiatrists, anesthesiologists, and emergency physicians, in particular, have the highest of all physician suicide rates. It’s been posited that this is because these fields involve incredibly high levels of stress, and access to drugs of abuse. For years, researchers have documented that depression combined with drug or alcohol addiction contributes to the likelihood that someone will commit suicide. And perhaps not surprisingly, the rates of depression and drug or alcohol abuse have also been found to be high amongst medical students and physicians.

A study recently published in the Annals of Internal Medicine has started to shine some much needed light on one of the variables involved with med student suicide. The authors found that one factor, in particular, was linked to the probability of a med student committing suicide. And guess what that factor was? Burnout. Should we be surprised?

I wrote an article last month that expressed my own feelings of burnout, and questioned whether or not torturing medical students was a valid method of education. I’ve since had even more time to reflect on these thoughts. I’ve also spent a good deal of time thinking about the death of my friend, and the factors that might have contributed to him making the choice he did.

Can I say that the pressures of medical school absolutely led to his death? Definitely not. But do I believe that the unbelievable amount of stress and pressure to do well in school contributed to his choice? Yes, I think I do.

Just today, I sat in an open discussion at my hospital, led by a senior physician. One student spoke up and complained about the fact that some residents and attendings had been very mean to him at times. He also mentioned the long hours, and the sometimes belittling treatment that med students receive. The physician's response? That’s just the way it is. That’s what he himself had to deal with to make it through medical school many years ago. And he said that when that student eventually becomes a resident or attending physician, he will also treat medical students the same way.

So, are we to believe that this is all simply a fact of life? Is this just the way it has to be? Is the stress simply inevitable? Are the resultant deaths also simply inevitable? Must this cycle of abuse continue, similar to the cycle of abuse in families?

I’m sorry, but I refuse to accept this as truth.

When Can a Doctor Refuse Care?

Kendra Campbell -- This morning, an article in the Baltimore Sun really caught my eye. The article described a new pharmacy opening up in Virginia that has decided not to offer any form of birth control for sale. I was shocked to find out that this pharmacy is actually located very close to a town that I lived in during my undergrad years, and hence the article really hit close to home for me (literally).

The debate over pharmacists’ right to refuse to sell birth control pills based on religious views has been going on for years now. Some states have passed laws defending this right, while others require pharmacists to offer birth control, regardless of their religious beliefs. For years, the American Medical Association (AMA) has been battling the American Pharmacists Association's policy, which states that pharmacists should not have to “engage in activity to which they object.” The AMA has voted to support legislation requiring pharmacists to either fill prescriptions or refer the patient to a pharmacy that will.

I support the AMA’s actions to protect patients’ access to pharmaceuticals, but the issue is much broader than just drugs. What about a patient’s right to have access to medical treatments? What about a doctor’s responsibility to provide care to all patients? This is, of course, a very heated debate, and is a sensitive subject for many.

The Differential’s Thomas Robey wrote an article that touched on the subject of a physician’s responsibility to provide therapies to patients. The debate is very old, and I can only offer a small amount of insight in this short article. But, it’s something that I feel strongly about, and I wanted to give an opportunity to others to air their opinions on this important subject.

In the AMA’s Code of Ethics, it states that a physician must “refrain from denying treatment to your patient because of a judgement based on discrimination.” But, the Code of Ethics also states that, “when a personal moral judgement or religious belief alone prevents you from recommending some form of therapy, inform your patient so that they may seek care elsewhere.”

Here comes my very provocative question. Where is the line between denying a patient care, such as prescribing birth control or even offering an abortion, and denying a patient care because a personal moral judgement or religious belief prevents you from doing so? If I deny a patient care because they are black, is that discrimination? Most people would say yes. If I deny a patient an abortion because it violates my religious beliefs, is that within my right? Perhaps many people would say yes. But what about denying a homosexual couple access to in vitro fertilization therapy because your religion doesn’t condone homosexuality? Would this be considered denying care because of discrimination, or is the physician's right to deny treatment protected, because of their religious beliefs?

The waters are clearly murky. What do you think?

Is Doing Nothing Sometimes Doing More?

Kendra Campbell -- I’m currently re-reading the famous book, The House of God, by Samuel Shem (Steve Bergman’s pen name). I read this book many years ago before ever starting med school, and I really enjoyed it. However, now that I’m doing my clinical rotations, I’m enjoying it with a new found appreciation, and I’m really starting to understand all of the subtleties and nuances of the story. I highly recommend this book to anyone thinking about going into medicine, med students currently doing clinical rotations, doctors, nurses, and just about anyone who enjoys a well written novel.

In the book, which focuses on the lives of interns in particular, the name “gomer” is given to the elderly, terminally ill patients that are always filling up the hospital, and who never seem to die. In fact, the first “Rule of the House of God” is that “Gomers don’t die.” The book gives an alarmingly accurate portrayal of how the main character, an intern, begins his internship with the medical student mentality that it’s possible, and in fact the doctor’s duty, to do everything possible to save a patient’s life. A much more seasoned resident tries to explain to him that for the gomers, this is not the best approach. Although the intern resists the advice of the resident at first, he soon learns the harsh reality that there is much truth to this approach.

Eventually the intern takes the resident’s advice and instead of “doing everything possible” to save the gomers, he does the exact opposite: he does nothing. Instead of running huge batteries of tests on the gomers, he doesn’t run a single one. Instead of administering all the medications and treatments that “medicine and science” would demand, he gives them little or none. And what’s the amazing result? The gomers end up doing way better on his watch. In fact, he becomes known as the hospital’s best intern, as he develops an amazing patient care track record.

I recently had an experience with a patient that was frighteningly similar to one described in the book (some details have been changed to protect patient confidentiality and to demonstrate my point). An elderly patient came in with the simple complaint of numbness and tingling in her arm. A chest x-ray was performed and showed a mass highly suspicious of lung cancer in the apex of her lung. A mediastinoscopy was performed in order to better visualize the mass and perform a biopsy. After the procedure, the patient developed a large hematoma and had to be rushed back into the OR to stop the bleeding. Because of blood loss, she ended up becoming very anemic, but couldn’t be transfused because she was a Jehovah's Witness. The patient also developed pleural empyema and eventually a chest tube had to be inserted. The chest tube ended up causing a pneumothorax, which had to be corrected. After the pneumothorax, the patient developed subcutaneous emphysema. After all this, she eventually developed a nasty case of hospital-acquired pneumonia. The story goes on and on and ends with the patient having a very lengthy stay in the hospital. In addition to that, the mass turned out to be inoperable and the patient eventually left the hospital with the same complaint that she came in with, in addition to having to deal with all the complications that arose from all the procedures!

While this is an extreme example of complications arising from hospital care, I think it serves to bring home my point. Would this patient have received better care if her doctors had simply chosen instead to do nothing? This is just one case, but I could describe many others where a very sick patient’s life was extended by a few weeks, only to cause them to endure countless complications and pain. How do we know when doing nothing is doing more? How and when do we make the decision to institute hospice care? I know hospice care is not “doing nothing” (actually, in some ways, it is doing much more), but it is a different (and I think in many ways better) method of approaching and caring for the terminally ill.

I have so many thoughts on this, but I’ll save those for another post. I’d love to hear what all of you think. Do you think choosing to doing nothing (in terms of medical treatment, not necessarily patient care) can ever mean doing more for the patient?

Common Things Are Common

Kendra Campbell -- There’s a famous saying in medicine that common things are common. This is a rather obvious statement, but is so very true nonetheless. Seven weeks into my surgery rotation, I can completely confirm this observation. Today on consult, I saw three patients with appendicitis, two with cholecystitis, one with pancreatitis, and one with gastritis. For general surgeons, these patients are the bread and butter of their practices. And just as the textbooks would have me believe, the appendicitis patients were all young males. The cholecystitis patients were fat, female and forty. The pancreatitis patient was an elderly alcoholic male. The gastritis patient was a stressed out, heavy drinker who abused NSAIDs.

Today’s patients represented about 85% of the patients I see every day. Throw in some hernias and DVTs, and you have the gist of my experience with general surgery. It really got me thinking about the curricula in medical school. It seems that 90% or so of what we learn in med school is about obscure diseases. We learn about Pompe’s disease, Klinefelter syndrome, and Creutzfeldt-Jakob disease, but how often do we come across patients with these pathologies? Sure, they do happen, and we need to be prepared for their presentations, but should we be spending over 90% of our time learning about them? We barely covered topics like pancreatitis and cholecystitis, but this is what we see every day.

I’m really not sure what the solution is. Physicians need to be well versed in most diseases and pathologies, but how much time should be spent covering these topics? Might our time not be better spent going over common maladies, their presentations, and their treatment?

I think one of the reasons that we have to cover all diseases is because by understanding their pathophysiological processes, we are better able to understand and appreciate normal anatomy and function. Learning about how the body can be attacked or go awry helps us to truly understand how the body works. And then maybe we are better able to understand and treat the common diseases that we see.

I’m not the first person to bring up this topic, and I certainly won’t be the last. Many people have discussed various changes that need to be made to the med school curricula. Should we really force pre-med students to take organic chemistry? Should we make students planning on going into psychiatry memorize obscure dermatological diseases? I don’t have a good answer.

Perhaps it makes sense to focus on everything that can possibly go wrong during our pre-clinical years, but then hone in on the more common diseases during our clinical years. For me, it seems like this is how things have been going thus far.

Another famous saying in medicine is that if you hear hoofbeats, think “horse,” not “zebra.” But the reality is that one day we might have a zebra walk in to the hospital, and we could make a grave error if we call it a horse. But for now, I guess I will continue to see and treat the horses, while trying to keep my eyes peeled for the black and white stripes.