Dead End or Trap Door?
Things do not always turn out like they seem. That has been the theme so far this semester. I am not referring to my experience in school. I am talking about our preparation for the real world. This is not a shock to the physician assistant vets out there and probably not to the students. When we read over a patient case and everything in us points in one direction, what do we do when the answer reveals something totally opposite?
I was reading over a case last week about a 31-year-old male who was in great health. He was on a jog and began experiencing chest pain and shortness of breath. The pain continued to get worse as he tried to rest from his jog. He came to the ED where all the gamut of tests were run, only to find that everything was normal. The final conclusion was that there was nothing wrong. We discussed this case in a small group and everyone had their opinion about the etiology. However, no one knew the answer. The professor later told us that there was nothing wrong with this guy and everyone was in shock. All the signs pointed to either an early MI or unstable angina, but how is it that there was no underlying problems?
Last semester, I read a book called How Doctors Think and the premise was that health care professionals can make thinking errors in subtle ways. We either go hunting for zebras and fail to see the horses or we play it safe and miss the big one. This stuff takes years of practice and exposure. We will never see it all and that is what makes this profession so exciting. Every day presents a new opportunity to learn. There is something inside of me that does not want to settle for “everything is normal with this one.”
I believe there is an answer for every manifestation of pain or lesion. However, I know that most of the causes out there are much bigger than me. I may not have the answer but someone else might. What was hard for me with this case was settling on the fact that nothing was wrong. Now this was a fictional scenario or maybe not; I did not write it. However, I have to ask myself, “Am I ok with the outcome if it is nowhere near what I thought?” I guess this is a part of learning. Sometimes we cannot be ok with the answer and dig much deeper, but I know there will be times when we dig and all we find is the truth. It is what it is.
I never thought these would be the things I would be learning in PA school. It never occurred to me that behind every set of signs and symptoms, there may not be a clear cut diagnosis. Does this make medicine an art? Do we require a sense of flexibility to think outside the box and sometimes be confined to the box? I want to be careful in settling with the dead ends because sometimes there is that trap door that leads to the other side. The challenge of medicine is knowing when to stop and when to continue when things seem out of place. I know this skill is not learned in school but in a lifetime of practice.