Kevin and David are not good at diagnosing

Most of you guys probably know this, but in the second year of medical school the curriculum takes a much more clinical turn. For every physiological fact we learn, we learn 3 things that can go awry with the body Xenu has blessed us with. This newly acquired knowledge has given us great diagnosing power. And with great power comes great responsibility… responsibility David and I have not exercised well.

It’s a common saying that when you hear hoof beats, think horses, not zebras. The main point is to steer diagnosticians towards the most probable diagnosis, however mundane, rather than the flashiest. To that I say “no thanks.” After all, House didn’t become a network hit by diagnosing tennis elbow and the common cold. In order to keep my diagnosing mind sharp, I’m always diagnosing my friends, classmates, strangers, the hobo that lives outside Julia’s window, etc etc. Unfortunately our batting average in this zebra clubbing contest is sitting at a paltry .166, well below the Mendoza line. Anyways, to better illustrate my point, I've created a little table of all the misdiagnoses we've made so far.


Can I think of this instead?

What we observed	Our differential diagnosis	What it really was / most likely is
1. Bloodshot eyes 2. Excessive desire to eat	1. Cicatrical pemphigoid With comordibity of: 1. Pica	Riding the Pineapple Express
1. Wrinkles 2. Brittle bones 3. Liver spots 4. Hair loss 5. Member of our class	1. Hutchinson-Gilford Progeria Syndrome	John S. (apparently he's just really old)
1. Dozing off in class	1. Narcolepsy 2. Myasthenia Gravis	Boring lecture
1. High blood pressure	1. Pheochromocytoma	Too much beef stew
1. Lack of verbal impulse control 2. Erratic class attendance 3. Severe paranoia	1. Schizophrenia	Jess
1. Asian guy with a cough	1. SARS 2. Bird Flu	Both SARS and Bird Flu

David has difficulty with doors

Like several other buildings worldwide, our med center has doors. Thus, unless I want to enter the premises ninja-style through an open window or scale the formalin-scented tresses of an MS-1, I must navigate a minefield of door-related obstacles to get my daily dose of brain food. This may seem trivial to most of you but, as evidenced over and over again in this space, I am severely challenged (Kevin’s the brains; I’m just a pretty face).


Here are only a few of the misadventures I confront on a regular basis*:

1) The never-ending door hold

If I’m entering a door and notice a person or two following behind me in close succession, I do what most others do and hold the door open to save them a bit of time and effort. Sometimes I just keep the door pushed open until the follower reaches me and takes over for him/herself. On other occasions, I go all out and employ the full-blown stand-aside-and-let-the-other-person-go-first maneuver. If there is a steady flow of people, this latter scenario can turn into the dreaded never-ending door hold, wherein each person is followed by another, and there is no clear opportunity to exit Entryway Purgatory and actually go inside. The only alternative is to play Door God and jump in front of a hapless soul whose expectation of a sweet door handout is tragically dashed as I dart into the line. That, simply put, is a power I feel unprepared to wield.

2) The second-door betrayal

Our med school has two sets of doors in close succession in one of its main entryways. The first opens from the outside into an indoor area with stairwells to the floors above and below. The second opens into the interior of the building itself. For all intents and purposes, they function as one single entry entity. Whenever I’m crossing through this dual deathtrap – a modern-day Scylla and Charybdis – and there is someone behind me, I typically open the door twice for them in turn, both times using the more casual push move described above. However, if I decide to use the full-on opening, this results in the other person passing me and taking the lead. Now, my initial gesture came with no strings attached, but one might reasonably expect that, one good deed deserving another, the other person would repay the favor and hold the second door for me. Alas, such human decency often goes unexpressed; the other party just races ahead without throwing even a weak attempt my way. Why, traitorous two-door turncoat, must you bring your renegade ways to our hallowed medical halls?

3) The wrong-way chest bump

This is one of the more perplexing breaches of acceptable doorway etiquette. It occurs when I am innocently approaching a double door on the appropriate right-hand-side, thinking to myself, “Boo-yah, I’m about to enter the crap out of this door. Get ready, people already inside, you’re about to be more numerous by one…” Then, right as I open the door and begin my glorious entrance, some random person coming from the other direction swoops in on the same side, my side, and tries to slip past me, conceivably to avoid the unbelievably difficult ordeal of opening the door on the opposite side. Unless this door poaching is executed perfectly – and even if it is, seriously, why? – the two of us end up in an awkward situation where we have to shift quickly to avoid running into one another. I’m left feeling sad, violated, and a little bit empty inside.

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*Credit goes to Jess and Luke, the resident MS-2 giant, for the inspiration for this rant. I couldn’t have done it without you two. Well, maybe I could’ve done it without Jess. Yeah, I definitely could’ve done it without Jess...

New poll up

Thanks to Scalpel or Sword, William the Coroner and several other blogs, we've received a large influx of visitors from all over the place, making our previous poll all but useless. Given the large number of new visitors, we're more interested in how often you guys check this blog so now there's a new poll off to the right . Perhaps the results will motivate us to produce more content in a timely fashion. But then again perhaps not.

Comic: Ideal vs. Reality - Gastroenterology

Seems like this series is slowly turning into a "Best case scenario vs. worst case scenario" kind of thing. Oh well, too late to change the name now.

David wonders when to wait while walking

Long-time readers of IDDx may remember previous entries Kevin and I wrote about awkward and/or strangely captivating interactions we had while walking in or around our med center. Today, another such scenario occurred, enabling me to complete the epic Really, Really Narcissistic Walking Post trilogy.

Allow me to explain…

After class let out this afternoon, Kevin and I started down the main walkway that leads from the med center to the primary bus stops and side streets that many students use to get home after a long day of edumacation. After a few minutes, we noticed Emily, one of our friends, walking behind us. She was close enough to recognize without difficulty, but far enough away that a wave wouldn’t necessarily grab her attention. I proposed waiting for her to catch up, but Kevin, who hates people, suggested we follow the Anti-Blackhawk Down Rule and leave every man behind.

This choice seemed fair, as Emily was a good hundred yards behind us and appeared engrossed in a phone conversation. Still, the event raised the question about proper Waiting While Walking etiquette that we inevitably beat into the ground. Specifically, how close must person A be before it becomes appropriate/expected for person B to wait for A to catch up? It’s probably a bit excessive to just wait for any person close enough for a positive ID. That might entail several minutes of waiting, and who knows if the other person is even interested in joint ambulation. On the other hand, it’s far more interesting to talk with a friend than it is to walk alone, so erring on the side of social interaction is always a plus.

Clearly, the decision is nuanced. Much depends on how well one knows the lagging party. If your girlfriend or close buddy were behind you, you’d definitely wait regardless of distance, but the Wait Zone diminishes significantly for mere acquaintances. Also relevant is the distance left to travel; if you’re a few steps away there’s little need to linger, but if you’ve got a mile to go both parties might enjoy a companion. Finally, there’s something to be said for avoiding the really awkward “Yes, I saw you look back, recognize me and then act like you didn’t and keep walking as if nothing had happened” scenario that I wouldn’t wish on my worst enemy (you’ve been spared, Jess…).

In the end, we concluded that the threshold distance is just close enough that the two people could communicate without resorting to strained yelling. If the rear party can flag down the leader without shouting too loudly, the person ahead is probably close enough to wait.

We attempted to test this theory with some “Can you hear me now?” trials, but one of those safety beacon things started beeping right where Kevin was standing. So, like any good scientists, we scrapped the experiment completely and just assumed we were right.

And by that time, Emily had caught up anyway…

Please vote... for our poll

Hey guys, some of you might have noticed that we added a little poll on the right side. We're interested to see how many people actuallly read our blog regularly and who you all are. Deep down we think its just our friends who are humoring us with pity visits, much like how parents think their toddler's handturkey drawing is an epic masterpiece.

Comic: Ideal vs. Reality - Summer Research