Diagnose me, student doctor!

One really tough thing about being a medical student is that everyone thinks you know lots of stuff and can help them out with any number of medical and diagnostic conundrums. It isn't that I mind answering questions; at least I wouldn't, if I actually knew the answers. That's the problem. At my stage, you don't know much of anything practical. The first two years are basic science, physiology, and the like. There isn't all that much medicine (Surprise! You came to medical school to learn medicine, but first, here are two hideous and painful years of genetics and biochemistry!).

You do learn some medicine; but as I said, what is really lacking is "practical" part. You see, the medicine you learn is the kind of stuff that would scare the living bejeezus out of people if you told them about it. What they mostly teach you are worst case scenarios, I suppose to prevent you from missing those and causing someone to die later on when you are actually doing medicine stuff. For example, the fact that a headache is just a headache in 99% of cases isn't really emphasized very much in the first two years. Rather, you learn about meningitis, epidural hemorrhage, West Nile virus, tumors, and a slew of other horrible things that it could be. We are taught that even something as innocuous as a runny nose could be—and again, it isn't as though this is likely, even if you have recently sustained a major head injury—cerebrospinal fluid leaking out of your brain. Do you see how this type of knowledge might be a problem when trying to council people about the possible cause of their typically completely benign symptoms? “Well, Aunt Molly, your abdominal pain could be that ten day old tuna you ate, or you could have a bowel torsion leading to ischemia which requires surgical removal of your colon so that for the rest of your life you will be pooping into a bag.” I therefore try to refrain from doing this, unless my last birthday gift from the person was less than satisfactory.

Of course, as I said, the alternative to knowing the most horrible possibility is simply not knowing any possibility. This is also very common. But your loved ones seem so confident in your abilities, so certain you will know the answer, so trusting, that it is hard not to just make something up on the spot. It’s important to make up a name that is complex enough that the loved one will not remember it, and then follow that up by telling them that they should talk to their doctor about it. You know: “Hmmm. That sounds like it could be superiomedial recurrent extraclavicular uvulitis. You should probably talk to your doctor about that.”

In any case, remember that most of what medical students know is worse than knowing nothing. Don’t ask for their opinion of anything, except maybe pizza toppings. In the meantime, I’d be happy to give you my opinions on what that strange rash might be. I’d have to go with leprosy.