18 July 2012

Case in point

Wednesday is fast becoming my favorite day of the week, because it's the day when the New England Journal of Medicine (a prominent medical journal) releases its newest issue. I immediately look at the latest installment of "Case Records of the Massachusetts General Hospital." It is a write-up of an interesting medical case seen in Harvard's main teaching hospital.

"Case Records" has been published continuously since 1924, and I think it is one of the most effective ways of learning medicine. A detailed write-up of the patient's history is presented. Then, a physician comes up with a differential diagnosis, predicts what disease he thinks it is, and explains his reasoning. Finally, the true diagnosis and outcome of the case are revealed, and an expert explains to the reader the mechanism of the disease at hand.

Reading through a case is rather engaging. After reading the patient history, I try to guess the diagnosis and then compare my reasoning to the physician's. The thrill of untangling the mystery of each case makes me want to learn about the disease. That there's a real human story behind each case makes the cases stick in my memory. By my tally, I've completed about 70 cases thus far.

Unfortunately, the cases take up an inordinate amount of time. Each one takes me anywhere from twenty minutes to four hours, because I try to read pertinent chapters in my textbooks as I go along. Some of my buddies poke fun at how ridiculous I look when I review a case in the med school library--I occupy a whole table, with all kinds of random medical books splayed about. Despite my best efforts, I haven't succeeded in getting my classmates to share my enthusiasm. After all, time spent studying cases is time not spent studying what will be on the test. It's not immediately obvious how I benefit.

Sometimes I present a professor with a case and ask them to explain a part that I didn't fully grasp. A handful of them have broken into a smile and revealed to me that they, too, used to study "Case Records" in their spare time when they were medical students. Now when I sit in the library poring over a case, I feel connected to an invisible community of eager medical students who, over the decades, have stolen off to the library to perform this same ritual, learning for learning's sake.