I have been keenly aware of my changing perspective over the years, noticing every so often that I've shifted a tiny bit more toward the latter (not only did I not truly understand the true meaning of the statement initially, I didn't understand the timeline- it's not an overnight change of perspective, unfortunately). My ignorant, egocentric first thoughts were that I, of course, was exempt- I knew it all already....
I had to stumble several times to realize how wrong I was. Seeing an elderly patient gasping for breath, of course it was his heart failure acting up! Imagine my surprise when the answer to my first question about his heart failure is a resounding, "I've never had heart problems." And then learning of his fever, cough and history of lung disease, I still hold out for a missed cardiac diagnosis. His wheezing couldn't be a COPD exacerbation or pneumonia- it has to be cardiac wheezing!
"The less experienced the physician, the less skilled he or she is in discriminating between what is likely and what is highly improbable. It takes much leavening experience to appreciate that oddities are rarely encountered and to know when it is appropriate to launch an intensive search operation."
(Dr. Lown, The Lost Art of Healing)
Our paramedic class designed a T-shirt, which I still have in my closet as a reminder- in large letters, it says "ZEBRA HUNTERS." I couldn't convince myself that sometimes things weren't zebras. "Zebra" is a common term in medicine ("if you hear hoofbeats, think horses, not zebras..."), usually referring to straightforward diagnoses like diabetes and high blood pressure.
Medical school only added fuel to my fire, adding lots of rare diseases to my arsenal. Rotating on the wards was no help either, I truly saw many "zebras." But is this really beneficial to an almost-doctor?
"Young physicians are filled with encyclopedic information of all the mayhem that can afflict a human being."
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