stupid, part deux

So, I got my board scores back from the biochem final. My wife says I need to be smacked down a bit to prevent me from getting a big head. By some miracle, I knocked the exam out of the park. Not every med school in the nation takes this one but of those that did, I scored in the top 1 percentile. When it got converted over to a number grade for our class, it was a 102.8....out of 100. It bumped my class average up to high pass, and only 1.8 points away from honors. Not sure how it happened. Only thing I can figure is that A) the profs did quite a good job at presenting to us the necessary material and B) this test was very different than the ones we take at school. As I said in the previous post, it was more doctory. It wasn't regurgitation. It was figuring out what ails a patient. That gives me a ton of confidence that I will actually be a good diagnostician. (I can't be a surgeon because despite performing thousands of surgeries on rodents (some quite complex and difficult) I shake pretty bad. It's one thing to have a mouse die on the table because one slipped. It's quite another thing to have a person.) I've had actual doctors tell me that I'll be good at this and then they get confused that I didn't seem to believe them. I guess I needed to prove it to myself. I also learned two other interesting things from this exam. 1 - nearly every single biochemical/metabolic disturbance leads to hepatosplenomegaly. Very non-diagnostic in these instances. Which leads me to #2. 2 - After reading about the 60th question of patient histories, it becomes tedious to read the same symptoms over and over and over . I could feel myself skimming to find the critical one. Hepatomegaly, fatigue, blah, blah, blah, blah, oh, they have lysosomal enzymes in their blood? That's I cell disease and the defect is in the mannose 6 phosphate process. Next! Now, I can completely understand how doctors don't appear to listen when you're reciting your complaints. Probably 90% of the patients in their waiting room have similar vague symptoms that are completely nondescript other than letting you know that something ain't right. They're looking for those 1 or 2 specific symptoms that let them zero in on a diagnosis. And they want you to hurry up and spit it out so they can figure out what's wrong and move on to the next patient. I need to not do that. The nondescript ailments are every bit as real and important to the patient as the diagnostic ones. After all, the discomfort of those general problems are probably what landed them in your clinic in the first place. I need to listen with both ears and full attention. That, and you never know when you might miss something.