“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” – Sir William Osler
Undoubtedly, you have probably experienced that one person in class always seems to have the unfair and superhuman ability to rattle off even the most esoteric details from specific sections of a reference. Then there are others who seem to learn in the heat of the moment, with adrenaline coursing through their blood vessels, as they attempt to and painfully fail at answering an attending’s question (this may or may not involve mind reading).
However, many agree that the greatest teachers of medical knowledge are the patients themselves. Their stories and ailments are audible, visible, and palpable. At times, it may be a particular hauntingly unforgettable odor that is the final piece of the diagnostic puzzle. And before the fortuitous advent of sweat chloride testing and urine glucose, a diagnosis could be rendered using the sense of taste. Thus, it goes without saying that the patient population that you will be taking care of as a doctor in training plays a significant role in your learning. On the one hand, there is a need to see the “bread and butter” cases that you are most likely to see after your formal training has been completed. On the other hand, there is also the need to see the so-called “zebras” that may mingle amongst the horses, i.e., the rare cases that test the limits of entire team’s diagnostic acumen.
Whether it is in the emergency center, in the hospital, or in the clinic, I have seen classic presentations of common problems, classic presentations of uncommon problems, atypical presentations of common problems, and atypical presentations of uncommon problems. Thus, although there may be a day during which I have seen 10 variations of the same viral upper respiratory illness during back-to-school seasons, this is matched by the 10 days during which I care for a patient with a disease entity that I may only see once in my entire career. Historically, All Children’s Hospital has been a regional leader with regards to specialty care, with even bigger aspirations for the future as a part of Johns Hopkins Medicine. That said, the same drive for innovation and providing quality care also applies to the general pediatrics and adolescent medicine clinic. And as is the case with the inpatient experience, the outpatient experience is also characterized by the same blend of complex pediatric cases and staple pediatric cases. I’m thankful for the privilege and the opportunity to serve as the primary pediatrician, with the appropriate level of supervision, for well children and medically complex children alike.
All Children’s Hospital is a great place to “go to sea” as a resident. There’s even a pirate ship here!
Alexander Y. Kim, M.D.
All Children’s Hospital-Johns Hopkins Medicine
Pediatric Residency Program, PGY-1