Practice Makes Perfect

Being a doctor isn't easy, and I don't think anyone would disagree with this comment. One of the hardest things to learn is how to take the information from the classroom and textbooks and apply it in a clinical setting.  This is why experienced doctors tend to make better clinical judgements than new graduates (everything else being equal).  It may not seem like it, but there can be a bit of disconnect between what is reported in the texts and what you may actually see.

It's common for doctors to talk about whether or not a patient "reads the textbook". This means that some cases present exactly like is described in the textbook.  For example, a hypothyroid patient would have a thinning coat, weight gain, and persistent skin infections.  However, some cases don't have classic characteristics, such as a diabetic patient without an increase in drinking or urinating.  It's easy for a doctor to read symptoms and lab results in a book or class notes and figure out what the disease is and how to treat it.  However, if the patient doesn't have all of the symptoms, or has some conflicting lab results, it can be difficult to make conclusions.  That's where experience and learned clinical judgement comes into play.

There is an art to medicine.  It takes experience to learn how to interpret lab results, determine what treatment is best, and how to implement that.  Lab results do not stand apart from the patient.  Two patients can have the same lab values but look and act differently. Conversely, you can have two patients with the same basic symptoms but radically different lab results.  You can have the same disease that presents in several different ways.  A newly graduated doctor has an incredible amount of "book knowledge", and knows a lot.  But they haven't learned how to apply that knowledge.  There is absolutely no way to teach this.  It only comes from seeing enough cases to learn the wide variety of presenting symptoms and clinical outcomes.

Believe me, this isn't disparaging newly graduated doctors.  Every single doctor was a "new grad" at one point, myself included.  I have had to learn many lessons of the years, and am a better doctor for it.  At the same time, I enjoy mentoring newer doctors as I always learn something from them. 

One reason for this entry is to caution laypeople about reading journal articles and text books and then interpreting their cases.  Yes, many times you can learn a lot and I don't discourage.  I also encourage people to be well-informed, ask their doctor lots of questions, and keep copies of lab results and medical notes.  But you have to be cautious in interpreting this information in light of your particular case. There is a reason why becoming a doctor takes years of intense education and why an experienced doctor's judgement is so critical.  Now, this doesn't mean that a given doctor will always be right...we're only human after all, and it's impossible to make perfect decisions every time.  But in general, an experienced doctor will know more than a new graduate and both will be able to handle cases better than a layperson.

For the educated layperson, this means that you should ask even more questions.  Like I mentioned last time, there is nothing wrong with respectfully questioning the "whys" of your doctor's decisions.  But a little knowledge can be a dangerous thing, and you should realize that no matter how much you read, this information can never compare to a doctor with the same information and years of experience.