Interesting Patients

When I was a senior internal medicine resident at Douglas County Hospital in Omaha, part of my job was to oversee education of the students and interns on our general medicine service.  The students were required to present a case for grand rounds once a week, which would be attended by the chairman of the department, our attending physician, and perhaps one other specialist in addition to all the residents, interns and students on our service.

The number of patients on the general medicine service at any given time was usually fairly high.  This made us all very busy and also kept us a good supply of interesting patients from which to choose our weekly grand rounds case study.

One particular week, however, we weren't that busy, and I didn't think we had any interesting patients to discuss at grand rounds.  I told this to my attending and asked that we cancel the conference for that week.

He was not at all happy with my request and firmly insisted that we definitely will have a conference that week and that a case will be presented for discussion, and that I'd better find one or he would be even less happy.  His contention was, of course, that there was always something about every case that would be interesting and educational for students and doctors who are interested in patient care.

Well, as it turns out, we did have a conference that week about an alcoholic patient with pneumonia who on first glance didn't seem very interesting, but brought up all kinds of educational material about community-acquired pneumonia, alcoholism, various pathogens to consider in this situation, risk of aspiration, potential complications, various treatments to consider, not just for the pneumonia, but also his alcoholism, the social and psychological aspects of his situation, the likelihood of recurrence or relapse and how to prevent it. etc., etc., etc.

I've often thought about this since then.  I learned very clearly that there is great truth to the saying, "There are no boring patients, only bored physicians."

The most important learning experience for me that week was that I had been very short-sighted in my assessment of how interesting patients are.  I had been thinking that if they didn't have some weird unusual problem like pheochromocytoma, they weren't very interesting.  

The truth is that there are many, many interesting things about every patient if you are interested enough to learn about them.

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This page was last updated on December 26, 2012.

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