Reflections on Medical Knowledge: Now and Forever

I have had many occasions in which I did not have the required knowledge or had thought through a case incorrectly, but I will talk about one specific occasion that comes to mind. I was working with a patient that came to the emergency department with a concerning area of erythema on his left thigh. It had been progressively enlarging but also changing in location slowly over the course of two weeks. I had initial concerns for some sort of cellulitis given the induration and erythema, along with limited tenderness. The picture was not completely clear to me as I did not have a good diagnostic schema for this presentation in my head. The more I dug into the symptoms and the exam, I began to realize that it was more likely to be some sort of thrombus. It ended up being thrombophlebitis, and a significant case at that. If there was nobody supervising me, or if I had rushed into diagnosis and treatment, I would have missed an important diagnosis and could have led to harming the patient, or at best, delaying treatment.

This reminded me that I should constantly be exposing myself to new information and consistently honing my diagnostic reasoning and differential building. I have appreciated the challenge coming from residents and attendings to really open my differentials and not to close in on something that I can explain by the presentation. Real patients have so many ways of presenting with the same disease. I know that this will come with time and practice, but I can expedite that process by constantly reading about common presentations of common diseases. I have learned that most patients come in with either common diseases or uncommon presentations of common diseases. I think that constantly challenging myself to more thoroughly explore pathology and treatment of common diseases, the more obvious something uncommon will become. I also know that having access to supervising physician, peers, and other colleagues, will surely be the way to home in on these skills.

In summary, I aim to constantly challenge my medical knowledge by staying up to date on germane journal articles and continuously updating standard practices based in evidence. I will continue to request instruction and to admit to my limitations of knowledge. I will also ask for impromptu explanations from senior residents and attendings in order to fully understand rational behind decision making and common practice.

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