Thursday, October 11, 2007

Thrilling thought of the week: I love Mondays

You know you've found the right graduate program when you look forward to Mondays.

I love Mondays because those are the days when we're presented with a new case to read through and drive our learning (see a previous post for more on PBL). Mid-week, when we're plowing through test results, synthesizing information from biochemistry and physiology and clinical manifestations, and sifting through sources that contradict each other, things aren't as much fun.

But Mondays, the sky's the limit. Everything that seems like it might fit -- a disease read about long ago, something someone's cousin once had, anything that sounds mysterious and interesting -- makes it up on the white board. Our new patient has abdominal cramps? Well maybe it's appendicitis. Maybe an STI. We should take her sexual history. How about abuse? Let's figure out her social situation. An exotic infectious disease? Let's get her travel history. Something related to a chronic condition -- does she have diabetes? Let's examine her, and maybe give her a pregnancy test

It's an exercise in medicine, but in the part of medicine that requires lateral thinking. Really, it's an exercise in stretching your mind to the limits of logic, and sometimes past that, just to make sure nothing's missed. With eight people in the room, ideas fly like ping-pong balls. The excitement rises as we exhaust all the possibilities we can think of and flip the page for more clues on our patient's problem. Eventually, most of our list will be crossed out as we learn more about the problem and its characteristics. But for a few minutes on Monday, anything is possible.

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