Saturday, May 7, 2011

Weekly Whine: Intellectual Curiosity

I think I've lost my intellectual curiosity.

I think it's been gone for a while. Like, years. Maybe more than a decade.

The first time I suspected I had lost my intellectual curiosity was during my intern year. I had a patient in urgent care with diffuse aches and pains plus some abdominal discomfort and low-grade fever. Her labs were normal except for some transient eosinophilia. So we talked to ID and they came up with the idea that she might have brucellosis. Everyone was so excited about working her up for brucellosis and talking about what an interesting case it was. "Wow, can you imagine? Brucellosis!"

Aside from the fact that the woman clearly had some sort of somatization disorder and not freaking brucellosis, it occurred to me that I was totally and completely unexcited by the idea that she might have brucellosis or some other rare entity. I honestly couldn't have cared less.

But I had to fake caring. I kept commenting, "Wow, that was such an interesting case!!" I hope it wasn't too obvious that I was completely full of shit.

For a brief time in residency, I thought I regained my intellectual curiosity, but I think I might have just been kidding myself. And now... well...

I get irritated when people want to work up chronic medical conditions on my short stay inpatients. Recently I had a patient who had been suffering from a neuropathy of some sort for over thirty years. She was supposed to be on our service one week for a hip replacement. Neurology got called in and I literally was forced to spend hours making calls and tracking down old EMGs and MRIs and trying to figure out the etiology behind this chronic neuropathy. And neurology was talking about how it was so interesting and wondering what was causing it. While the truth was I couldn't care less.

We're not going to figure out the etiology of a chronic disease during a short hospital stay when our most advanced piece of technology is an X-ray machine. You want a work-up so badly? It's called an "outpatient referral."

It's kind of sad that I lost my intellectual curiosity though. It's one of those things that keeps you from being unhappy as a physician.


  1. I don't think that necessarily has anything to do with intellectual curiosity. Frankly if 'intellectual curiosity' was the only reason for the consult, it was probably a waste of medical dollars. Intellectual curiosity is all well and good, but I agree with you about the "interesting cases". It is good to have a well developed DDx, but one attending told me "you are more likely to see a rare presentation of a common illness than a common presentation of a rare illness". While we always want to do more for our patients, acute care is not the place to work up stable chronic conditions 99% of the time.

  2. I agree with Erin.

    On the last day of my sub-i, one of the new interns (it had just turned July) was taking over my patient -- a chronic homeless alcoholic admitted for EtOH withdrawal with a massive necrotic foot ulcer. She heard that I wanted to be a neurologist (she was going into neurology herself) and asked me in the most saccharine patronizing tone of voice imaginable what the cause of his neuropathy was. She then reacted with horror and scolding when I told her we hadn't (and wouldn't) work it up.

    I was like, woman, we are trying to keep him from having a seizure here. Who CARES why he can't feel his feet!

  3. Sometimes it has to do with burnout as well. But that is what made me realise earlier this year that I was probably barking up the wrong tree career wise when I found other things so much more interesting (even if just Grass Is Greener Syndrome I think it is the right decision).