Remember When Medicine was Fun?
Share your experiences with new medical students

I remember taking physical diagnosis as a sophomore medical student. I was thrilled the first time I saw the optic disc on retinoscopy and the first time I heard a pleural rub. Deep tendon reflexes fascinated me, as did learning to differentiate between the natural dislike of having one’s abdomen mashed by an inexperienced medical student and the startling rigidity and rebound tenderness of true peritonitis.

After 25 years of practicing medicine, it still is fun. I have never experienced any reward more thrilling than seeing a patient get well because of something I have done to help. There is no greater satisfaction than having a patient genuinely thank me for making him better. That’s why I’ll be sharing my experience with medical students Sunday, Aug 25, at the annual Medical Student Dinner.

I’ll let them know that even what seems frustrating now will get fun later. Learning to recognize heart murmurs was not as much fun for me as it was for my fellow students. They seemed to recognize these strange new sounds rather easily, but I listened intently and often heard nothing. At first I could hear only the ones that were grade 6/6. As a student, I doubt I ever recognized a murmur that was less than grade 3/6. For me, the “fun” part of murmurs had to wait until I was in private practice. When I do my preoperative physical exams, I listen to the heart with the patient supine, in contrast to the common physical exam by internists, where auscultation tends to be done sitting. On rare occasions I will hear a murmur in the supine position that was inaudible in the sitting position. Although these positional murmurs typically are not of clinical significance, when I call the patient’s internist and discover that he had not heard a murmur in that patient, it gives me a minor feeling of vindication for the suffering I went through while learning to hear murmurs.

As a junior medical student, I loved learning about each new disease that presented itself on my clinical rotations. It was fun doing an elective rotation with Dr George Bryan, studying pediatric endocrinology. Dr Bryan had quite a few patients with the adrenogenital syndrome. It was fascinating that an error in the metabolic pathway of steroid synthesis could have such a profound effect on the physical appearance of the baby, producing female babies with such clitoral hypertrophy that they were frequently misidentified as males at birth. Correcting the metabolic problem medically was fairly easy. But watching Dr Bryan deal with the tremendous social problem of children with mislabeled gender gave me a real appreciation for the art of compassionate caring for the patient and family.

As an intern and resident, I alternately was terrified and exhilarated as I mastered each new problem in diagnosis and treatment. Despite the long hours and sleepless nights, it indeed was fun to feel the sense of accomplishment that comes with gradually mastering the diagnostic (and, in my case, surgical) skills necessary to practice the art of medicine.

Even during my two years in the Navy, there was some fun to be had. I diagnosed a case of Addison’s disease in the dependents’ walk-in clinic. On exam, the patient looked both acutely and chronically ill. She was tachycardic and had blood pressure of 80/60. When I opened the textbook, I discovered she had the classic physical findings of Addison’s disease. Her admitting laboratory work also was typical, and she responded promptly to saline infusion and then steroids. In 24 hours, she was an entirely different person. She is one of my rare “trophies” of medical diagnosis as a surgeon.

A more recent one was a patient I saw a year or two ago for abdominal pain. She told me she had intermittent attacks of pain and sometimes hematuria during these attacks. She mentioned that no one had been able to document red cells in her urine. Having done the appropriate tests to make sure her colon was not the cause of her pain, I told her it sounded like she had porphyria. I asked her to see an internist and be checked for that. When she came into my office this year for an unrelated problem, she said, “Do you remember that you said I might have porphyria? Well, I do!” Making a diagnosis of a rare medical problem is truly fun for a surgeon!

So, do you remember when medicine was fun? I hope your answer is the same as mine: “It still is!”

On Aug 25, DCMS will host its annual Medical Student Dinner at the Renaissance Dallas Hotel, 2222 Stemmons Fwy, from 6–8 pm. I hope you’ll come meet the new class of medical students, and share with them the fun and joy of practicing medicine that you have experienced. To make your reservations, contact Connie Webster, DCMS director of community service, at 214-948-3622 or connie@dallas-cms.org.

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