Life in a general neurology practice, over time, becomes a routine. Migraines, dementia, strokes, neuropathy, back and neck pain … the things that are, as they say, the “bread and butter” of the job. So much of this job is spent thinking inside the box that some days it’s hard to remember we have to keep an eye on the outside of it, too.
Unlike my academic colleagues, I’m not a huge fan of zebras. I prefer my life, practice, and cases uncomplicated and straightforward. Horses suit me better. But, like everyone else in this job, I occasionally find a zebra. Recently, a fellow was referred to me for imbalance, but his appearance concerned me enough that I thought something outside the usual considerations was there. When all was said and done, he’d been diagnosed with myotonic dystrophy.
And, as much as uncommon diagnoses can drive you nuts, when you stumble across one AND get it right, it’s exhilarating – like a home run, a 3-point shot, or an interception returned for a touchdown. That’s especially true if it’s something treatable, and you can make a real difference in someone’s life.
A key part of medical training is the differential game – where an attending repeatedly grills you with the question, “And what else could this be?” making you think of both obvious and far-fetched possibilities.
This part is probably one of the most hated during training, yet very appreciated years later. Where I trained, it was the focus of a much-dreaded conference held every Thursday morning around a huge table. You were forced to think of the unordinary things that are the pitfalls of medicine. Today, I realize how valuable those 90-minute, weekly sessions were.
Although none of us realizes it at the time, those are the things that make you a better doctor. The brief thrill of catching a zebra never gets old. And it’s always coupled with a deep appreciation for those who taught me to hunt them.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
