I think part of a good medical education requires that the student doctor become confident in himself or herself. Physicians have to make some tough decisions from time to time, and if you weren't confident in your thinking then you'd really never do anyone any good.
I remember my first day of third year rotations. I started out on neurology and had no idea what I was doing. I was told to go see my first patient BY MYSELF! I went, woke up that poor lady, and stayed in her room for about an hour asking her all kinds of crazy questions that may or may not have been relative. I fumbled through a physical exam. I'm sure she thought "good riddance" after I left!
After 1 quick year I have progressed from that fumbling bumbling med student who spends an hour on physical exam, to a fourth year who is left in the ER to admit patients alone with just a quick check-in by an upper level resident. I can see about 2-3 new patients in an hour and am confident in my physical exam findings. And my brain works a lot better too. Present me a constellation of symptoms and I can get the right diagnosis most of the time. And I have to admit, I like this new confidence. It feels pretty good when you get things right.
But last night I admitted a patient that makes me think otherwise. He's a charming Philippino guy who's young and has his whole life ahead of him. He works hard on a marine vessel to support his wife and child back home. He told me his story of what his life was like back home, how he lives on the boat now, and about this nagging nausea with a little low-grade belly pain he's been having. He's also lost some weight. But the real driving force for him to come into the hospital was being shocked a few days back when he turned yellow all of a sudden. Eyes and all!
With my almost-physician brain, I immediately think of the medical term "painless jaundice" and how it's almost never a good sign. More often than not it's a ticket to an untimely death. I try to not show much concern on my face and proceed with his physical exam. His belly is a bit tender, but I spend more time focusing on his neck. Two large firm lymph nodes move around under my fingers. I think the amount of time I spent on his neck made him nervous. I had never felt enlarged lymph nodes that were so firm, and I wanted to make sure I felt right. He nervously looked up at me and asked in broken English if those were bad. I suddenly wished I could take a time machine back to 1st year of medical school and say "I don't know". I'm sure my face said differently.
After finishing his exam and talking with my residents and attendings, a CT scan was taken which is so far presumed to be what I thought it was: cholangiocarcinoma. This is a very nasty cancer that forms in the bile ducts of the liver. Most people get it when theyre very old. But he has a risk factor: being from Southeast Asia and exposed to certain kinds of parasites in his food that can cause this cancer.
This is one of those things it doesnt feel good to "get right". Id rather be wrong.
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