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Do I Know Anything? Like Anything at all?

July 27, 2017


This is a relatively common question that many 3rd year students ask themselves time and time again when starting on the wards. So, post-Passing Step 1, you feel like you know everything. Well, maybe not everything but you feel like you know some things, dare I say, many things BUT within your first one or two days on the wards, you begin to realize that you know NOTHING. Not one thing. I might be exaggerating a little but after filling your head with what you presumed to be all completely necessary medical information (like all of those enzymes in the glycolysis pathway), you feel ready because that's what the first two years of medical school is for make you ready for clinicals. 


Now, don't get me wrong all of the pharmacology, pathology, microbiology and physiology that you bang your head against desks learning in those first two years IS completely relevant and integral to your being able transition into years 3 and 4, BUT the only time I have actually heard anyone mention anything biochemistry related was when I was on my Cardiothoracic surgery rotation and my Attending was telling me how they use Kreb cycle intermediates during Bypass because they are cardioprotective. So yeah, I'm still waiting to run into a patient with Von Gierke's Disease.  Nevertheless, me complaining Biochem (which I actually love), is not the point of this post.  This post is about the crazy steep knowledge curve that you endure when starting on the wards. 


We are taught during the first two years of medical school the function and form of the human body and how that body responds to infection, disease and drugs. In a nutshell. We are also taught how to perform physical exams, write notes (kinda sorta), interview patients, come up with a differential diagnosis and make a plan. Again, kinda sorta.  But the challenge really comes when you get to the wards, you see a patient and you can maybe figure out what is going on with them but then you have to figure out what to actually do to treat them.  One would think that this should not be that hard but it is completely the opposite, especially when first starting out.  When you actually have to figure out what medication to prescribe, how much to prescribe and you have to make sure that none of their other medical conditions are contraindicated to giving that particular medication and if they have an infection to make sure that you are putting them on the appropriate antibiotic(s) with the proper coverage for all of the bugs that you should be concerned for t...and you are literally just like WUTTTTTT, as you're trying to remember that sketchy micro/pharm drawing in your head. (Major Key- you won't be able remember those sketchy image fast enough on rounds, trust me). OH, And then you have to make sure you address every "acute" and/or issue that is going on with your patient and having to figure out what to actually do for that problem. And don't even get me started on giving fluids, what type to give, how much to give, who even gets fluids vs. who gets fluid restriction...And again you are like WUTTTTTT. 


Nevertheless, although you tend to go through each day feeling slightly inadequate about all the things you may not know or some of the things you may miss, on the other hand it is the most rewarding thing to learn so much EVERY.SINGLE.DAY.  Although there is still so much to learn, I am continually amazed by how much more I know today compared to 5.5 weeks ago when I first started on IM.  


The point is that this learning curve is supposed to be steep because as our current knowledge may have allowed us the recite the fact that left heart failure is the most common cause of right heart failure, you find that you learn infinitely more about exactly how that happens when your patient comes in with an acute on chronic combined heart failure exacerbation and you're able to look at CXR (chest x-ray) and ECHO (echocardiogram- ultra sound for the heart) results and have it actually make sense. That is medicine. It is the fact that we have filled our minds with the fundamental understanding of the what, why, how, etc in the first two years of medical school, but now it's actually looking at a real patient, implementing and applying that knowledge and being able to actually practice the art of medicine and learn how to heal that same patient. The curve is steep but it is absolutely beautiful. 

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