Breaking News
May 3, 2019 - Vaping and Smoking May Signal Greater Motivation to Quit
May 3, 2019 - Dementia looks different in brains of Hispanics
May 3, 2019 - Short-Staffed Nursing Homes See Drop In Medicare Ratings
May 3, 2019 - Study of teens with eating disorders explores how substance users differ from non-substance users
May 3, 2019 - Scientists develop new video game that may help in the study of Alzheimer’s
May 3, 2019 - Arc Bio introduces Galileo Pathogen Solution product line at ASM Clinical Virology Symposium
May 3, 2019 - Cornell University study uncovers relationship between starch digestion gene and gut bacteria
May 3, 2019 - How to Safely Use Glucose Meters and Test Strips for Diabetes
May 3, 2019 - Anti-inflammatory drugs ineffective for prevention of Alzheimer’s disease
May 3, 2019 - Study tracks Pennsylvania’s oil and gas waste-disposal practices
May 3, 2019 - Creating a better radiation diagnostic test for astronauts
May 3, 2019 - Vegans are often deficient in these four nutrients
May 3, 2019 - PPDC announces seed grants to develop medical devices for children
May 3, 2019 - Study maps out the frequency and impact of water polo head injuries
May 3, 2019 - Research on Reddit identifies risks associated with unproven treatments for opioid addiction
May 3, 2019 - Good smells may help ease tobacco cravings
May 3, 2019 - Medical financial hardship found to be very common among people in the United States
May 3, 2019 - Researchers develop multimodal system for personalized post-stroke rehabilitation
May 3, 2019 - Study shows significant mortality benefit with CABG over percutaneous coronary intervention
May 3, 2019 - Will gene-editing of human embryos ever be justifiable?
May 3, 2019 - FDA Approves Dengvaxia (dengue vaccine) for the Prevention of Dengue Disease in Endemic Regions
May 3, 2019 - Why Tonsillitis Keeps Coming Back
May 3, 2019 - Fighting the opioid epidemic with data
May 3, 2019 - Maggot sausages may soon be a reality
May 3, 2019 - Deletion of ATDC gene prevents development of pancreatic cancer in mice
May 2, 2019 - Targeted Therapy Promising for Rare Hematologic Cancer
May 2, 2019 - Alzheimer’s disease is a ‘double-prion disorder,’ study shows
May 2, 2019 - Reservoir bugs: How one bacterial menace makes its home in the human stomach
May 2, 2019 - Clinical, Admin Staff From Cardiology Get Sneak Peek at Epic
May 2, 2019 - Depression increases hospital use and mortality in children
May 2, 2019 - Vicon and NOC support CURE International to create first gait lab in Ethiopia
May 2, 2019 - Researchers use 3D printer to make paper organs
May 2, 2019 - Viral infection in utero associated with behavioral abnormalities in offspring
May 2, 2019 - U.S. Teen Opioid Deaths Soaring
May 2, 2019 - Opioid distribution data should be public
May 2, 2019 - In the Spotlight: “I’m learning every single day”
May 2, 2019 - 2019 Schaefer Scholars Announced
May 2, 2019 - Podcast: KHN’s ‘What The Health?’ Bye-Bye, ACA, And Hello ‘Medicare-For-All’?
May 2, 2019 - Study describes new viral molecular evasion mechanism used by cytomegalovirus
May 2, 2019 - SLU study suggests a more equitable way for Medicare reimbursement
May 2, 2019 - Scientists discover first gene involved in lower urinary tract obstruction
May 2, 2019 - Researchers identify 34 genes associated with increased risk of ovarian cancer
May 2, 2019 - Many low-income infants receive formula in the first few days of life, finds study
May 2, 2019 - Global study finds high success rate for hip and knee replacements
May 2, 2019 - Taking depression seriously: What is it?
May 2, 2019 - With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters?
May 2, 2019 - Scientists develop small fluorophores for tracking metabolites in living cells
May 2, 2019 - Study casts new light into how mothers’ and babies’ genes influence birth weight
May 2, 2019 - Researchers uncover new brain mechanisms regulating body weight
May 2, 2019 - Organ-on-chip systems offered to Asia-Pacific regions by Sydney’s AXT
May 2, 2019 - Adoption of new rules drops readmission penalties against safety net hospitals
May 2, 2019 - Kids and teens who consume zero-calorie sweetened beverages do not save calories
May 2, 2019 - Improved procedure for cancer-related erectile dysfunction
May 2, 2019 - Hormone may improve social behavior in autism
May 2, 2019 - Alzheimer’s disease may be caused by infectious proteins called prions
May 2, 2019 - Even Doctors Can’t Navigate Our ‘Broken Health Care System’
May 2, 2019 - Study looks at the impact on criminal persistence of head injuries
May 2, 2019 - Honey ‘as high in sugars as table sugar’
May 2, 2019 - Innovations to U.S. food system could help consumers in choosing healthy foods
May 2, 2019 - FDA Approves Mavyret (glecaprevir and pibrentasvir) as First Treatment for All Genotypes of Hepatitis C in Pediatric Patients
May 2, 2019 - Women underreport prevalence and intensity of their own snoring
May 2, 2019 - Concussion summit focuses on science behind brain injury
May 2, 2019 - Booker’s Argument For Environmental Justice Stays Within The Lines
May 2, 2019 - Cornell research explains increased metastatic cancer risk in diabetics
May 2, 2019 - Mount Sinai study provides fresh insights into cellular pathways that cause cancer
May 2, 2019 - Researchers to study link between prenatal pesticide exposures and childhood ADHD
May 2, 2019 - CoGEN Congress 2019: Speakers’ overviews
May 2, 2019 - A new strategy for managing diabetic macular edema in people with good vision
May 2, 2019 - Sagent Pharmaceuticals Issues Voluntary Nationwide Recall of Ketorolac Tromethamine Injection, USP, 60mg/2mL (30mg per mL) Due to Lack of Sterility Assurance
May 2, 2019 - Screen time associated with behavioral problems in preschoolers
May 2, 2019 - Hormone reduces social impairment in kids with autism | News Center
May 2, 2019 - Researchers synthesize peroxidase-mimicking nanozyme with low cost and superior catalytic activity
May 2, 2019 - Study results of a potential drug to treat Type 2 diabetes in children announced
May 2, 2019 - Multigene test helps doctors to make effective treatment decisions for breast cancer patients
May 2, 2019 - UNC School of Medicine initiative providing unique care to dementia patients
May 2, 2019 - Nestlé Health Science and VHP join forces to launch innovative COPES program for cancer patients
May 2, 2019 - Study examines how our brain generates consciousness and loses it during anesthesia
May 2, 2019 - Transition Support Program May Aid Young Adults With Type 1 Diabetes
May 2, 2019 - Study shows how neutrophils exacerbate atherosclerosis by inducing smooth muscle-cell death
May 2, 2019 - Research reveals complexity of how we make decisions
Doctor or detective? Sleuthing mysteries in medical school

Doctor or detective? Sleuthing mysteries in medical school

A professor recently romanticized
my idea of clinical reasoning as he began our session by saying, “When you’re a
physician, you’re a detective.” He elaborated: “Every fact you have, every
piece of evidence you have, must be consistent with your leading diagnosis.” As
he said this, my eyes narrowed, and I sat up a little taller.

My fellow first-year medical students and I have begun our official training in clinical reasoning, the bread and butter of medical practice. For the first time in medical school, I’ve felt the sweet satisfaction of cracking a case, like in scenes depicted on TV dramas.

As part of our training in spotting clues, we’ve spent the first three weeks of the quarter learning how to read electrocardiograms (EKGs), a heart functioning test that measures waves of electrical current passing through the heart. To answer the question, “Is this graph healthy or life-threatening?” we’ve been told to examine the squiggly waves of heart beats and construct something meaningful. A seemingly benign line-drawing can sound the alarm: “Act quickly! Danger is near!”

Noticing something as small as the
difference between a wide or narrow curve on the graph is a matter of sending a
patient home or admitting them to the hospital.

After our professor made his point,
I considered the similarities between doctors and detectives. In the wake of a
crime, somebody calls the detective. Waking from illness, somebody calls the
doctor. Detectives interrogate witnesses of the crime, while doctors ask
questions to collect a medical history. Detectives search the scene for clues
and evidence, while doctors examine the patient’s heart, lungs, and bones to
find clues and evidence within the body. Detectives make a list of all possible
suspects, while doctors make a list of likely diagnoses.

In both scenarios, there’s a
methodology, and sometimes a thrilling and mysterious adventure. However, the
thrill of scientific discovery for physicians is rightly squashed by the
gravity of dealing in matters of life or death. While I spend a lot of my time
in learning labs with classmates, I know the cases we review are based on real
patients with life-altering prognoses. For many people, the innocuous EKG
reading turns out to indicate heart disease. Somewhere along our training, we
have to learn to strike that delicate balance between intellectual intrigue and
empathy while navigating how a diagnosis affects patients’ lives.

On my way to learning the methods
of a sleuthing detective character worthy of TV shows, I’m far from the
equivalent of Sherlock Holmes. For now, I more closely resemble Inspector
Clouseau in The Pink Panther: a bumbling fool, misled down every
corridor, mistaking feet for hands on X-rays. In the midst of learning the
entire language and culture of medicine, my classmates and I rely heavily on
our professors (and each other) to impart some rhythm to the motions. However,
the process of tiny satisfactions along the way, small “wins” in learning,
motivate me in a journey that is notoriously fraught with failure and burnout.

When I shared this idea with a classmate of mine, he reminded me that there’s “a lot of faking it until you make it.” In The Pink Panther, he may look a bit foolish along the way, but he eventually ends up solving the crime. While it’s a long and slow journey, I’m excited for the day when I master these skills of deduction, along with charismatic compassion.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Lauren Joseph, LoJo, is a first-year medical student from Arcadia, California. She graduated from Stanford in 2017 and spent one year working in San Francisco before starting medical school. She is thrilled to be back at Stanford. She loves cooking, reading, running, and laughing with friends and family. 

Photo by 422737

Tagged with:

About author

Related Articles