My Sword!

I’m now 4 weeks into my first clinical rotation and I’m finding it as exciting, challenging, interesting, stressful, inspiring, and overwhelming as I thought it would be. I am currently at the family practice office located in the Center for Health and Healing. I work with a friendly and hard-working staff as well as knowledgeable and engaging healthcare providers/teachers. My preceptor, Adam King, is a great mentor and example of what a good Physician Assistant should be.

These first weeks have been demanding. I have had my eyes opened to how much I need to improve. One of my biggest challenges is formulating a differential diagnosis.

For those who don’t know, the differential diagnosis is the foundation for medical thinking and decision making. It is your list of possibilities that could be affecting your patient, given their symptoms. It is the job of the healthcare professional to ask questions, examine, and run tests to cross the most dangerous and the most common things off that list until the problem is apparent.

I’ve never been good at formulating lists in my head. Have you ever played Scattergories? I’m awful at Scattergories. So formulating a good differential diagnosis has been very overwhelming and anxiety producing for me. Chief complaint: “dizziness” …oh geez… My mind goes blank and I suddenly empathize intimately with the patient.

Finally, last week, Adam said something that really hit home with me. He was talking about questions to ask patients and how they should be based on your differential diagnosis. He said “your differential is your sword.” It was a simple statement but it completely shifted my perspective. I realized that thinking of the differential as a mountain to be climbed was never helpful. It is a tool to use in my approach to the patient. Right now, being so new to this, my blade is pretty dull and I can’t always cut away all I need to. Over the next year I will be sharpening it with the whetstone of many patient interactions and the advice of wise clinicians.

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