Island Med Student

There’s a famous saying in medicine that common things are common. This is a rather obvious statement, but is so very true nonetheless. Seven weeks into my surgery rotation, I can completely confirm this observation. Today on consult, I saw three patients with appendicitis, two with cholecystitis, one with pancreatitis, and one with gastritis. For general surgeons, these patients are the bread and butter of their practices. And just as the textbooks would have me believe, the appendicitis patients were all young males. The cholecystitis patients were fat, female and forty. The pancreatitis patient was an elderly alcoholic male. The gastritis patient was a stressed out, heavy drinker who abused NSAIDs.

Today’s patients represented about 85% of the patients I see every day. Throw in some hernias and DVTs, and you have the gist of my experience with general surgery. It really got me thinking about the curricula in medical school. It seems that 90% or so of what we learn in med school is about obscure diseases. We learn about Pompe’s disease, Klinefelter syndrome, and Creutzfeldt-Jakob disease, but how often do we come across patients with these pathologies? Sure, they do happen, and we need to be prepared for their presentations, but should we be spending over 90% of our time learning about them? We barely covered topics like pancreatitis and cholecystitis, but this is what we see every day.

I’m really not sure what the solution is. Physicians need to be well versed in most diseases and pathologies, but how much time should be spent covering these topics? Might our time not be better spent going over common maladies, their presentations, and their treatment?

I think one of the reasons that we have to cover all diseases is because by understanding their pathophysiological processes, we are better able to understand and appreciate normal anatomy and function. Learning about how the body can be attacked or go awry helps us to truly understand how the body works. And then maybe we are better able to understand and treat the common diseases that we see.

I’m not the first person to bring up this topic, and I certainly won’t be the last. Many people have discussed various changes that need to be made to the med school curricula. Should we really force pre-med students to take organic chemistry? Should we make students planning on going into psychiatry memorize obscure dermatological diseases? I don’t have a good answer.

Perhaps it makes sense to focus on everything that can possibly go wrong during our pre-clinical years, but then hone in on the more common diseases during our clinical years. For me, it seems like this is how things have been going thus far.

Another famous saying in medicine is that if you hear hoofbeats, think “horse,” not “zebra.” But the reality is that one day we might have a zebra walk in to the hospital, and we could make a grave error if we call it a horse. But for now, I guess I will continue to see and treat the horses, while trying to keep my eyes peeled for the black and white stripes.

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