We Still Don’t Know What’s Wrong

A few years ago, I was talking with a medical student who had just finished a shift in the ED. He was an excellent student, but today he had a string of patients who left him frustrated. The 40 year-old woman who presented with abdominal pain left the ED with a diagnosis of “abdominal pain.” We discharged the 35 year-old man who presented with a severe headache with a diagnosis of “possible tension headache.” A five year-old girl with a fever left with “fever of probable viral etiology.” We had gotten blood tests and a CT scan on the woman with abdominal pain, the results of which were normal. We had treated the man’s headache with analgesics, and he got better. We had given the five year-old some Jell-O when she stopped vomiting, and she was playing happily with some toys. The student said, “These people came in bent over in pain or crying. We put them in a bed. We talked to them and examined them. We ordered some tests. A few hours later, they felt better, and we sent them home. They walked out standing up straight and smiling. But we didn’t really do anything. We never figured out what was wrong with them.” I had to smile because, in many ways, the student was right. He had been learning about the dangerous causes of headache–subarachnoid hemorrhage, meningitis, brain tumors. But he had not learned much about tension headache, or migraine–the causes of most headaches that often improve on their own. He had learned about pancreatitis, appendi...
Source: Academic Medicine Blog - Category: Universities & Medical Training Authors: Tags: Featured From the Editor ambiguity specialty choice tolerance for ambiguity Source Type: blogs