Knowledge is Power, Knowledge is Pain

Posted on March 26, 2011


Why do I say knowledge is pain?  Well, for one, you can’t unlearn what you come to know (though, put an exam in front of me and I’ll prove myself wrong, if you’d like).  More importantly, however, you become a resource to your loved ones – this is empowering for all parties involved, but is also the root of a great deal of stress.  It’s clichè, but acquiring medical knowledge is both a blessing and a curse.  These thoughts were compiled several weeks ago – I withheld the post while waiting for a true diagnosis regarding one case.  -Jim

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Med students complain.  A lot.  In fact, we’re frequently asked “Well, then why are you doing it?”  For some of us, it’s because we feel trapped by our decisions or the expectations of our families, but for the vast majority, it’s because we really want to.

If you were to ask me right now — “Jim, what’s the worst thing about being a medical student?” — the answer might surprise you.  It’s not the mindless memorization, the 14-hour study marathons, the performance anxiety , or even the fact that people at the next level continually tell you “Just wait, it gets worse!”

It’s the dreaded random medical question.

What, don’t I like applying my newfound medical knowledge to solve challenging problems?  Of course I do, however, unlike Miss Cleo I do not sit around eagerly awaiting your call so I can impress you with my telemedical diagnostic skills. To you, it’s just a question, but we will rack our brains and loose sleep over this stuff (but will never admit it).

The information sets aren’t ideal, and although those from real patients rarely are, it’s difficult to provide an answer without a basic medical history or a list of medications, etc.  With that in mind, take a look at some of the (paraphrased and anonymized, of course) questions I’ve faced from friends and family, all received in the last two months:

  • Friend:  Two of my fingers were tingly, and I went on WebMD – do I have multiple sclerosis?
  • Friend:  I have this rash on my knuckles that bleeds, what’s going on?
  • Family:  I have an itchy rash on my face, what should I do?
  • Friend:  I think I had a stroke/transient ischemic attack (TIA).
  • Family:  How much eyesight will I gain back after my stroke?
  • Family:  How a pneumonia can precipitate heart failure.
  • Family:  I got my blood test results, will you go over them with me?  (Actually, I love doing this!)
  • Family:  My diabetes is getting worse – why is my blood sugar so high?
  • Family:  The doctors found something in my lung and I need a CT scan, I think I have lung cancer.
  • Friend:  Have you heard of [my congenital eye disorder]?
  • Family:  My blood work showed a [paraprotein] band and I got a referral to an oncologist for more tests, what’s going on?
  • Friend:  My friend’s [relative] has leukemia, how long do they have to live?
  • Friend:  My mother thinks she has gout.
  • Friend:  via text message: Can I take ibuprofen while I’m drinking?
  • Family:  My urine tests showed hematuria [blood in the urine], do I have prostate cancer?
  • Friend:  My mother was found to have abdominal mass, is it cancer?
  • Friend:  Allergy crisis – do I need to go to the hospital?
  • Family:  I’m getting [elective, cosmetic] surgery in two weeks, what is the rationale behind this restricted pre-surgery diet?

I recall, very early in my training, being approached in a coffee shop while studying with a friend – a young man wanted to know what to do about his self-diagnosed tennis elbow, but couldn’t afford to see a physician.  People tend to think you learn the simple things first, then the complex, but that’s not really how medical school works.  We were pretty much clueless beyond being able to parrot “NSAIDs” at him – oh, how I wished he had asked me about G-protein coupled receptors that afternoon.

It’s not all bad, of course – it’s a wonderful feeling to be able to tell someone, with some degree of confidence, that everything’s going to be all right when they’re worrying about their health.  For many of us, being able to periodically validate our career choice is very important, so we generally welcome health-related questions (and hopefully, we’re altruistic people if we’ve even considered entering medicine).

Just keep this article in mind the next time you’re thinking about asking that medical student (or doctor) in your life what he or she thinks that rash could be – you’re not the only one with a question, and sometimes, like everyone else, we need a day off.

By the way, sometimes complaining is the only outlet we’ve got, so let us have it, will ya?

“Knowledge is of no value unless you put it into practice.”

-Anton Chekhov

Bonus:  The second-worst thing about being a medical student?  Middle-aged men coming up to you at summer parties and asking, “So if I eat a few more burgers and have a heart attack, you’ll be able to save me?”  No.  You’re going to kick the bucket while we’re waiting for the paramedics to arrive.

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