Easy II

The counterpart to the last post is that the further one goes in training, the harder medicine gets. As a medical student, medicine is simple. We're taught knowledge at it's cutting edge; what we learn and see is the most evidence-based and current. We also learn "classic textbook" presentations of diseases. We do things based on the teaching, not experience, so we rarely face dilemmas. When we don't know something, we ask.

But as we become residents, we have to diagnose those odd-ball presentations. We have to build that experience to intuit whether nausea without chest pain could be a heart attack or dizziness could be a stroke. Few things are "textbook." And residents in the healthcare system are the workhorses, getting things done. At the same time, they are supposed to practice evidence based medicine, demonstrating quality patient-centered care. Indeed, the residents I work with can quote studies spontaneously, citing not only the major conclusions, but also the study's downsides. They work the hardest hours, they know the most, they make our system work.

And then we get to the attendings who have the hardest job. They exist to prevent people from falling through the cracks and to stop the cracks from widening. They teach, they are expected to be experts in what they do, and they are the source of much of our evidence base. They have to think ahead in what medicine needs both for a patient and as a field. They anticipate, they refute, they think.