Monday, April 24, 2006

The House Effect

It's probably unfair to call this the "House effect" because this problem predates that show by a few decades, but I'm going to anyway.

House effect: obsession (of both teacher and student) to know (in detail) the aspects of a disease that you should never see in your entire life.

I learn that 95% of all tumors of the gallbladder are adenocarcinomas. Ok, I'm fine with that. What I'm not fine with is a page of notes then devoted to the minutiae of that remaining 5%. It's not necessary. It wasn't necessary after I learned that 90-95% of lobar pneumonias are caused by strep. pneumoniae, and it isn't necessary after I learn that 98% of all peptic ulcers occur in the antrum of the stomach and in the duodenum. You can keep your 2%; I don't want to know it.

Under the same logic, I should NEVER HAVE TO KNOW ABOUT ANTHRAX. I'm staring at two pages of Anthrax notes right now, and while I feel very prepared to hold my own against a talking head on FOX NEWS, I sure as hell know that I will never put this information to clinical use. And let's say, for argument's sake, that I did? Let's say ten years from now I see a case of anthrax: I'm calling the CDC and letting them cough up their lung (which is what everyone should do, regardless).

The logic of the last 5% is pretty simple: if you treat 100 patients you'll see it 5 times, so you need to know it. I understand and respect this. I also understand that all the truly useful things I ever learn will be on-the-job. So if during rotations my Resident decides that I really need to know the 5%, then I'll know it. But just imagine how much more useful it would be if every medical student walked out of the first two years knowing 1) the top five causes of everything or 2) the causes that cover 95% of cases. Instead, I feel like I lose sight of the forest because the people writing my tests think the ant on that piece of bark on that rare tree is too interesting to skip. So I should probably know that instead.


At 12:17 PM, Blogger Jarrad said...

I"m only a first year, but I'm convinced that a hell of a lot of what we are learning in medical school will never be used in the real world. I hereby swear that the first patient I cure because I can draw out the exact molecular structure of every intermediate step in the glycolysis cycle, I will buy them dinner in the country of their choice.

Thanks for putting a link to my blog, that's cool of you. I'll return the favor when I get a chance to sit down and clean my site up...

Good to meet you.

At 11:53 AM, Anonymous Anonymous said...

Now just imagine you are interested in psychiatry, and went to medical school to become a psychiatrist.
Welcome to 3.5 years of learning and being rigorously tested on the 2% of rare peptic ulcers. As well as the 98% that you will also never see, except in medical school.



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