Being a fourth-year med student is kind of like being a college senior all over again, but with even less sh*ts to give.
Weekends were free. Nightly reading became nightly TV marathoning. Suddenly, my classmates and I had “meetings” that started anywhere between 2 and 4:30, depending on how bold the individual was.
At my longitudinal clinic site, I felt like Marcus Welby, MD. So when I saw a 56-year old Spanish-speaking male presenting with chronic abdominal pain, I knew within 30 seconds that it was gallbladder-related. He reported sharp, constant, right upper quadrant pain associated with nausea. His labs and imaging were normal, except for a lipase of 101 and glucose of 397.
I laid out my diagnosis to the patient and even explained to the pt what the course of action would be, like getting more labs and a possible surgery consult. Yes, I was a champ.
My preceptor thought otherwise. “There’s so much that says it’s not cholecystitis!” she said. I blinked in surprise. My face probably got red. I just felt a little, teensy bit incompetent then.
No matter whether you’re a first-year, a fourth-year, a senior resident or have been in practice for thirty years, medicine keeps you humble. When you reach a stage when you think you can stop learning, where you can’t make a mistake or can substitute arrogance for correctness, that’s where you fail as a doctor.
For this patient, it turned out that I had overlooked an EGD/colonoscopy which was positive for H. pylori. We decided to treat him for that to r/o any gastritis-related pain. And I made a resolution to read about H. pylori gastritis and to never satisfy myself with slam-dunk diagnoses again.