i am a brilliant diagnostician! (someone tell my residency director)

sometimes i see a patient with an unusually complex set of problems or symptoms.  for whatever reason, i just can't figure out what's wrong with them, or what to do with them, or how to proceed.  sometimes i can't even figure out who to refer them to to help me - which ologist do i choose?  in those instances i think to myself - this person needs a good internist! and then i picture the general medicine professors of my clerkship years - their crisp white coats and graying hair, their confidence and their calmness and their seemingly endless knowledge - i worshipped them.  i wanted to be them.  i wanted to know everything.  they were masters of their trade and i was a stumbling apprentice.  they were not just good internists, they were great!

those clerkship years are now well behind me. and even though i don't wear a white coat, once in a very great while, i am that internist! i am the one to figure it out - to filter and synthesize and process a complex set of symptoms and draw the right conclusions.  it is a good feeling.

i received a call this morning from a neurologist to whom i had recently referred just such a patient - a very healthy female who could wake up one day feeling fine, then suddenly feel as tired and lifeless as a wet dish rag for the next four days, and then once again be fine.  she had been to doctors before, she had been hospitalized during one of her episodes, she had even seen a specialist and had numerous tests done -- all with no diagnosis (hmmm... sounds like the making of the next mystery diagnosis episode). so she went on with her life.  when the episodes struck, as distressing as they were, she just waited them out. 

when i met her, i had absolutely no idea what was wrong.  i listened to her description of her symptoms. i reviewed all the prior tests and labs she'd had done.  and to be completely honest, in my mind i even briefly thought - she seems normal but is she making this up? is she crazy?  i still had no idea.  i even had her come in during an episode so i could examine her myself.  then i did what i always do when i'm stuck - research (well, actually, when i reach an impasse like this it boils down to either research or referral, but since she'd already seen the specialist, i chose research).  i looked up what i thought were her key symptoms and came to the conclusion that she had xxx disease (now before you think she had some strange super female DNA, know that xxx is just me bleeping her real disease for privacy's sake).  making a tentative diagnosis in that way is far from being able to appropriately counsel and manage a patient with that disease, so i asked her to see a neurologist to see if he concurred with my initial impression. he did.

first of all, how nice of him to actually pick up the phone and call me.  i didn't expect that but i sure appreciated it.  and then he said two words that really made my head swell - i'm impressed.  should i  have told him that i'd never even heard of xxx disease when i met her?  that i'd googled her symptoms in my nifty online medical data base?  i said thank you.

this is one of the many reasons i love my job - my patient is happy to have a better understanding of her road ahead, i am happy to be appreciated by a colleague whom i've never even met before.  what more could i want!  my head should  return to normal size tomorrow.