21 October 2011

A walk through the valley of the shadow of death

"Medical student syndrome" is a mainstay of medical training: many students become convinced that they or those around them are experiencing the symptoms of some of the diseases they study. I don't feel like I am suffering from the syndrome, but learning the sheer variety of diseases has made me more frightened of succumbing to one. I had been blissfully ignorant of most of the myriad ways our extraordinarily complex body fails. I now find myself worrying more about aging and about those I love falling ill.

Becoming acquainted with death and its pernicious relations is part of the burden and privilege of medical training. Soon we will be assuming shared responsibility for our patients' well-being, and we must know their enemies to best protect against them.

Fretting that things might be more serious than they appear can be a mark of a good physician. If a teenage patient breaks his femur while playing football, it's one thing to repair the leg and cast it. It's rather another to step back and wonder if the bone had broken because it was weakened (perhaps by cancer or an endocrine disorder). Seemingly innocuous complaints (muscle twitches in the leg) can have unlikely but serious conditions in their differential diagnosis (amyotrophic lateral sclerosis, aka Lou Gehrig's disease). This decision of whether to pursue a case further is informed by years of experience, something I currently lack.

I was taught that one needs to feel concern in moderation; too much worry is disabling and too little is reckless. I hope to strike the right balance, for my sake and for my patients'.