I got an A?

Yesterday, my patient gave me an A. My preceptor (the doc whom I shadow/help/learn from every few weeks) had left the room and given me the chance to interview the patient. On coming back, my preceptor asked the patient, conspiratorially, "So, how'd she do? An A-? B+?"

My patient, a lovely woman, and now one of my favorite people ever, gave me an A. Which, of course, made me really happy. It also has limited value, because I didn't actually have to produce any results -- the patient's treatment didn't depend on me, and the patient wasn't familiar enough with the history-taking process to know what questions I'd forgotten or not followed up on thoroughly enough.

But, I don't think it's meaningless. It says something (albeit small, I know, you don't have to remind me) about how I interact with patients. I actually do think I've gotten better at speaking with and listening to patients, at turning the "patient interview" into a "patient conversation."

But, a few minutes later, as my preceptor and I examined the patient's heart, I completely failed to hear what turned out to be a quite distinguishable heart murmur.

So, the point: medicine contains within it a huge set of skills, and a whole lot of information. It's so different from anything I've studied before because it has a well-defined end-point -- to be able to effectively treat patients -- and yet is so vast. A first-year who has improved in one area is likely miserable in a whole lot of others. And not only is it difficult to learn everything, but it's also hard to know how fast you should be learning. It's as if the "fire hose" that is medical school has created a puddle around you, and you're now trying to figure out if it's best to tread water or drink yourself to dry land. And how much you can drink at once without making yourself sick.