Class of 2020
Alexis del Vecchio
“Hey, J, how long could I have had mono before I started having symptoms?”
I stood there, with perhaps the dumbest look on my face, as all my scrambling brain cells gave out a collective, “Uhhhhhhhhhh…”
“Well, what I can tell you is that mono is caused by the Epstein-Barr Virus, or EBV, and it infects B-cells through the CD21 receptor. So, if we looked at your blood in a microscope, we would find atypical lymphocytes. This virus is in the Herpes family of viruses, has double-stranded, linear DNA, and has an envelope around itself. In order to test for this in the lab, they will use a Monospot test. This test uses red blood cells from horses or sheep to determine if your body is making the antibody to this virus. The virus is associated with other things too, like aplastic anemia and Burkitt’s lymphoma.
“But…no. I don’t know. I don’t know how long you’ve probably had mono…but don’t play sports!”
This happens all the time. Family, friends and new acquaintances find out you’re in medical school, and, from then on, you become a personified WebMD search bar. I don’t say that begrudgingly at all; it’s certainly understandable that we as medical students would be asked questions, just as I would ask questions of anyone in their respective field. But what is perpetually frustrating is not knowing the answers to their questions. And I’m not talking about difficult, impractical questions, like “What’s the name of the person who discovered the mono virus?” Surprisingly, I can answer that! No, no, no. I’m talking about questions like, “How long will I be sick?” or “What common side effects can I expect from this drug?”
It’s not that we don’t learn about sickness and drugs. But you have to understand how med school works. We breeze through the common stuff, because that’s not what comes up on Step 1 (one of the national board exams critical for our career). The side effects of this drug 99.999% of the time are nausea/vomiting? Well so it is with 937483291587 other drugs, too, so you can bet that’s not going to be a test question! No, what we write down on flashcards, all over the walls, and on our bathroom mirrors are the 0.001% of rare, specific-to-this-drug type of effects that can leave you with a weird rash on your pinky and passed out in a roadside ditch. Why? Because when I ask you about what led to the man with a red, itchy finger on the side of I-85, you can choose answer “D,” medschoolacillin.
Here’s an actual example of this scenario playing out recently (credit to my classmate, Andrew Buhr, for pointing this out to me). We just learned about a disease that for this blog post I’ll call, “x.” Now this disease occurs every year in 2 out of 100,000 people. Of those 2 people, 5-10% are due to a genetic mutation, and 25% of the time, it’s a mutation in an enzyme that I’ll call “y.” That means that between 2-3 people out of 10,000,000 patients each year will get disease “x” because enzyme “y” is mutated. Two out of ten million. But we better know that mutation for the test, and probably what chromosome it’s on too.
Is it important to learn these facts? I’d say some of the time, of course. That uncommon drug effect could be fatal and absolutely worth knowing. But they get the priority of our time since they’re the most frequently tested, so things we’ll see every day as physicians go by the wayside. For example, take the conversation with my brother-in-law. Were we ever taught how much time there is between catching the mono virus and when symptoms appear? Yeah, I’m sure it was mentioned—in passing, of course, and tucked away in the un-bolded corner of the PowerPoint slide. You know, right between the giant microscope picture we’ll never see as doctors and the highlighted DNA description that helps me to do what, exactly?
Then add to all this frustration the information we learn just because the test is so far behind the science. I can’t tell you how many times we’ve heard “We don’t see this disease anymore…” or “This lab test hasn’t been used for 15 years…” or “This drug has been completely replaced clinically by these better drugs…” And yet, these statements always end with, “…BUT you need to know this for Step 1.”
And it’s not just stuff that is “behind the times.” Sometimes it’s just the way the testing system is structured. Did you know we are only required for Step 1 to know the generic names for drugs? That means we learn about esomeprazole, atorvastatin, and fluoxetine. Ever heard of them? How about Nexium, Lipitor, or Prozac? Same drugs. But I could never have told you that before this blog post. Sure, it’s easier now to remember one less name for the exam, but what happens after the test? When we’re in the hospital next year and patients and healthcare providers are throwing around the terms Bactrim, Humira, and Ambien, and I’m over here struggling to translate?
Why is this how our medical education system works? Is it because med students are just lacking in the amount of information we need to know? Obviously not. But it’s a problem that needs addressing, because the amount of medical knowledge keeps growing exponentially. Fifty years ago, we had no idea what caused mono, or even that it was a virus. Now I can tell you what it looks like, down to the shape of its DNA. How can we as medical students keep up with the influx of all this new knowledge? Will we continue to be required to memorize phone books of facts and figures, when we can now access a world of information by simply “asking Siri”? Or will we focus more on training the problem-solving deduction that a doctor must possess?
I’d like to know the answer to these questions. I wish this was a blog post with answers. Unfortunately, just as I sat there dumbfounded with my brother-in-law and his mono questions, so do I sit here now, surrounded by my thousands (not exaggerating) of flash cards, pondering their relevance to me as a future doctor.
I don’t know the answer…. but it will probably be on Step 1.
Formerly from the Baltimore area, I graduated from Bob Jones University with a degree in pre-med. Having interacted through MedEx with the faculty and students, I knew the doctor USCSOMG will graduate was the doctor I wanted to become. If I’m not hitting the books, you can probably find me spending time with my better half or on the basketball court. It is an honor and a privilege to be a member of the class of 2018, and I’m excited to share my passion for emergency medicine and health education with my peers. “To whom much is given, much more shall be required.”
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