Medicine Isn't Always By the Book

When you are in med school, you are taught how to do things by the book. You read about and are tested on “textbook cases.” You are instructed on the “one most appropriate initial test” and the gold standard of diagnosis. You learn about the most cost-effective treatment. You study algorithms, tables, and flow sheets.

And then you actually get to see patients. Patients who obviously haven’t read the textbooks, and unfortunately do not have the “classic findings.” Or worse, they have read the textbooks (or more likely the Internet), and are convinced that they do have the classic findings.

And when was the last time you only got one initial test? If you have differential diagnoses, to spare the patient from repeated trips to the labs for blood draws, don’t you typically order several tests?

And as for cost-effective treatment? Well, sometimes, “more effective” or “more convenient” trumps “cost effective.”

You know what they don’t prepare you for in med school (aside from the morass which is the business side of practicing)? They don’t prepare you to explain to patients why other doctors do what they do. They don’t prepare you to sit there straight-faced while the patient tells you that Dr. Smith told them this or, worse, sold them that. Now I realize there are a lot of gray areas in medicine, and there isn’t always a clearly right or wrong way, but how do you tell a patient that what they have been told (or perhaps what they interpret they were told) is so far from “by the book” that it might as well be “wrong."

It can be frustrating and confusing trying to figure out these deviations from “the book,” but I suppose that’s what keeps things interesting.
 
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