"ummmmmmmmmmm..."

We have a new class that is supposed to help us transition from the lecture-based to the clinical-based part of medical school called Doctors Patients and Communities, or DP&C for short. We generally call it Doctors Patients and I Just Wasted Another Two Hours This Week.

We were recently practicing case presentations. This is where you describe a patient that you have seen, the patient's complaint, the medical history, the symptoms, physical exam findings and your differential diagnosis, or DDx. A DDx is simply a list of possible disorders a patient could have, given the symptoms.

One girl was describing a 45-year-old man who came into the Emergency Department complaining of severe chest pain on the left side, shortness of breath, with the pain shooting toward his back and down his left arm. His history was significant for high blood pressure, high cholesterol and diabetes.

At this point in the presentation, one of the Docs running the small group stopped the presenter and asked if anyone had one possible disorder to go on the differential. In classic med-school style, the Doc simply picked someone in the class, I'll call her Lisa, to give one possible disease consistent with those symptoms. Lisa stares ahead like a deer in headlights.

I felt bad for Lisa, I'm sure she was daydreaming and was not paying attention to what was going on and had no idea what we were talking about. Could have happened to anyone.

So the silent stare went on for maybe 15 seconds.

The Doc then decided to make it easy for her and said, "C'mon, just give me one possible item on the DDx for a middle-aged man with severe left-sided chest pain radiating to the left arm and shortness of breath with a history of high blood pressure and high cholesterol."

It was a fucking softball. One disease, one possible disorder for this guy. Children on the playground across the street were trying to signal her with several no-brainer disorders.

Again, silence for at least 15 seconds. Followed by a squeaky little voice that said:

"ummmm........maybe something cardiovascular?"

Well BRA-VO, Dr. House. Amazing, really. That startling breakthrough in clinical medicine only took you two years in medical school, which included not one but two classes in cardiovascular physiology and pathology, not to mention the minimum once a week visits to various wards in the ten hospitals affiliated with our school.

I called my niece (who's seven) and asked her what is wrong with someone if they have a really big pain in their chest, they can't breath and their arm hurts.

"Which arm?", she adorably asked
"The left arm", I replied
"Duh, heart attack.", she said.

Well, I guess Lisa was right, it was "something cardiovascular".