The Distance

I have learned that the path to becoming a doctor is not linear. Which drives the Type A, OCD, perfectionist individuals attempting to do just that, a little crazy. The problem with learning almost everything there is to know about the human body, is that you're learning almost every little thing there is to know about the human body. Which means that for most of us, it's impossible to do in one pass. So instead of taking a linear path from point A to point B, it's more like you're running a path that twists and turns back onto itself. You're exposed to the same material different ways at different times. Each time you pick up a little more.

My school's curriculum is problem based, and instead of learning in lectures, we learn in small groups where we're presented with a case. Most of the time it feels a lot like House. With less snarkiness and condescension. (Usually.) Our cases consist of a "patient" presenting with various symptoms. Then we work through the case, getting patient histories, coming up with differential diagnoses and ordering lab work, etc. We finally get to a diagnosis and then we pick readings from our text books about whatever pathology or disease our patient had.

These cases used to take forever. Our first case we ever did, a pediatric case where the kiddo had trisomy 21, my group took four two hour sessions to work through. And that case was relatively straight forward. The reason it took so long was because we didn't know anything. We spent hours looking up what blood test and urinalysis results meant. Deciphering an abnormal physical exam from a normal physical exam. Trying to figure out exactly what we were looking at on imaging studies. Learning the difference between respiratory and metabolic acidosis and alkalosis and whether or not they were being compensated. It was tough.

Today, we got through a pretty complicated case - our patient ended up having HIV, fungal infections, herpatic lesions, exposure to tuberculosis and a host of other problems - in one hour. Now we know what to do. We know how to take a history. What we're looking for on a physical exam. What tests to order (most of the time). What a list of legitimate differential diagnoses looks like (pretty much).

If medical school was linear it would be easy to mark your progress. To check off the boxes of things you knew when you learned them and then give yourself a gold star for being super. But it's not. And sometimes, it's easy to forget how far you've come because you're focused on how much farther you've still got to go. But today as I overheard the first years arguing about what different lab tests meant, I felt happy and thankful to be doing what I am doing. And grateful for the reminder that while I've still got a lot to learn, it's less than it was a year ago.