It's So Cute When They Try

“Gordon, why don’t you go and see Mr. M on your own and then we can discuss his case?"

Oh, thank you mystical powers above. It’s finally happening. My longitudinal clinic preceptor is throwing me the reins. I get to stroll in to a patient room with my white coat and my notebook and pretend I’m actually a somebody. I get to try my hand at diagnosing something real. I’m the boss. This must be how the NCAA men’s basketball national championship team feels when “One Shining Moment” blares as the players try to not choke on confetti.

Then came sweaty palms, a lurch in my stomach, and mind-numbing terror. Oh my God. How stupid will I sound if I stumble all over myself? What if the patient realizes that I actually have no idea what I’m doing? Will the university cover my legal expenses when I accidentally poke the otoscope right through Mr. M’s eardrum? 

Dr. L saw the hesitation in my eyes, gave me a motherly pat on the back, and said, “Stop worrying. It’s not like you’re going to do anything that can accidentally kill him.” Wanna bet? 

“Hey Mr. M! My name’s Gordon, and I’m the medical student working with Dr. L today. It’s a pleasure to meet you.” My eager hand shot out toward his, following the familiar script that I had rehearsed so many times in standardized patient interviews.

Mr. M, a mildly obese man in his 50s who was on several medications for hypertension and arrhythmias, came in with concerns regarding some mild, intermittent chest pain that had started three weeks prior. Immediately, my mind flipped to everything I knew about cardiac and respiratory conditions, which at the time was pitifully little. I ran through the standard interview protocol--chief complaint, review of systems, medical, family, and social histories--without a hiccup. My self-esteem up, I stood convinced that the school should’ve just handed me my diploma right then and there because I was just so dang GOOD AT THIS.

As I was about to give my little scripted wrap-up Oscar speech, Mr. M chimed in hesitantly.

“Oh, and there’s something else…do you know much about ED?”

ED…ED…oh right, Ehlers-Danlos. Crap, I know it’s a congenital connective tissue disorder, but not much else. Oh well, I’ll just ask him about his family history of connective tissue problems and wing it from there. Two minutes into my line of questioning, my patient’s quick evolution from gentle smile to angry demands for why I was asking him how far back his parents’ fingers can bend made me realize that I was completely on the wrong path. Embarrassed, I hurriedly excused myself from the room and presented the case to Dr. L. Upon describing the puzzling change in Mr. M’s demeanor, Dr. L gave me a classic facepalm and explained to me what I had done wrong.

Now, most people with any common sense would have figured out that he was, of course, asking about erectile dysfunction, a problem already difficult enough for most men to discuss without being questioned about “places on your body where you’re stretchier.” I, defying all laws of logic and statistics, managed to ignore the mainstream assumption entirely and made myself look really foolish. Despite my best efforts, I had fulfilled those pre-interview fears.

As medical students, we learn about numerous fascinating diseases that have all sorts of fun buzzword descriptors that “show up on the boards all the time” but, funnily enough, never in real life. Our mental Rolodexes like to jump to those far, dusty corners, believing that we’ve found that one-in-eight-hundred-thousand case so we can show off to the attendings. The designation of these uncommon conditions--“zebras”--takes root in the idiom “When you hear hoof beats, think horses, not zebras.” Common things are common; you’re far more likely to see an atypical presentation of a common disease than textbook symptoms of a rare one. Yet, we spend so many classroom hours learning about the zebras that eventually we train our minds to go on wild safari hunts by default, always searching for our next white whale. This, of course, is where experience comes in. This is why we swallow our fears and see patient after patient, hoping to come out each time with a little more diagnostic know-how so that we make fewer mistakes in the future. Let’s not lie to ourselves--at the end of the day, the major driver for doing all the learning we do is simply the fear of sounding completely stupid to strangers and superiors. We all might as well have “fake it ‘til you make it” tattooed to our foreheads.