Back to the Books

Now I remember why I didn’t want to be an endocrinologist!

My internal medicine board certification is set to expire at the end of this year. It lasts for ten years at a time, which seems pretty long until the end gets in sight. Well, the end is now in sight. Bummer.

The internal medicine certifying exam is quite hard. A lot of the questions end with a twist. I’ll be reading the clinical vignette thinking – “I’ve got this! Yes it’s an unusual case but clearly the diagnosis is __________” only to find the question at the end is not “what is the diagnosis? but rather “the best treatment is __________” and five potential treatments (all of which are good for that condition) are listed. Which is best? Why? Back to the story for more clues. It can be pretty frustrating.

I don’t really need to be board certified anymore. My clinical practice days are over, and my most recent administrative jobs have been very high level. But it feels bad to let the certification go. So I’ve decided to hit the books and take the test.

I’m enjoying the studying. It reminds me of when I was a “real doctor” and medicine is indeed very interesting. But it’s also a bit intimidating. There’s so much to learn. A lot of new things in ten years, but even reviewing the basics is a massive and daunting undertaking. Did I really know all this once?

Honestly, I put my chances of passing at 50/50 with the amount of work I’m willing and able to accomplish in the next 4½ months. More will be revealed.

In any event, I’m trying to learn more than just the facts. What higher-level messages am I getting during this process? Here are a few that I already knew (and you probably do too) but are coming to me with renewed force:

Your physiology is very, very, very complicated and finely tuned. Everything interacts with everything else. It’s all connected. Your body really is extraordinary, a marvel, even a “miracle.” If you’ve never studied biology, it would be worth it to learn just enough to be convinced of this through your own study. It could change how you think about your health – or your life.

When something goes wrong, other things are apt to go wrong. This is a natural corollary of “it’s all connected.” I learned this from simple observation in resident clinic. Serious conditions occur together. If you have one, you’re likely to have a bunch. Not all of them are avoidable, but try not to get that first one. Take care of yourself.

Many serious illnesses don’t have an identifiable cause. Some are autoimmune conditions, but then what exactly causes auto immunity? Others are more obscure. Perhaps unidentified genetics or environmental issues are at fault. We just don’t know, and perhaps some cause will be identified sooner or later. For now, sometimes what you get is what you get and there just is no explanation. That’s a hard message.

Doctors have a tough job. There’s so much to know and a great deal of judgment is necessary to balance risks, benefits and competing priorities in managing any reasonable complex individual patient’s situation. Normal physiology is complicated. Pathophysiology is more so. Then you’ve got the various diagnostic tests – sensitivity, specificity, risks, indications, contraindications, etc. – and the treatment options come with a similar set of issues. Back when I was a doctor, this was everyday stuff, not something to moan about, but now that I’m out of practice I have a growing respect for those who are still in the trenches.

As my studies progress, I’ll try to revisit what I’m learning, but this seems like enough for now. My basic message – It’s no fun to be sick, and sickness often snowballs. Take care of your health as best you can. Even then, things might go wrong for no apparent reason. If they do, find a doctor you trust to walk with you on your journey.

And, although it’s not in any of my study materials, trust God.

Pete

_______________________________

You made all the delicate, inner parts of my body
and knit me together in my mother’s womb.
Thank you for making me so wonderfully complex!
Your workmanship is marvelous—how well I know it.
Psalm 139:13-14 NLT

Speak Your Mind

*