Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.

HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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I understand how stupid it is to go into medicine solely based on a TV show but on a related note to that post, how often do you actually have puzzles to solve in family medicine? How many intellectually challenging cases would you, or a real-life doctor in a specialty similar to House's, get? Obviously you're not gonna be getting a case of smallpox from someone who was cut while diving in an 18th century shipwreck, but do you often have cases that are interesting and difficult to solve?
wayfaringmd wayfaringmd Said:

Whoa, I forgot this question was in my inbox. My bad. 

Well, every patient you see is a puzzle. The puzzles range from 10 piece kiddie puzzles to 1000 piece 3D jigsaws. Some don’t require much thought, while others can be very challenging. 


Many patients will have something about their case that makes you go “hmm”. It may be something like “what drug did they overdose with,” “why is their sodium 124,” “what’s causing that weird feeling I get when I talk to the family,” “they’re allergic to every antibiotic I want to give them” or “is this appendicitis or something ovarian”. 

In the hospital, I’d say that maybe 1 in 40 patients is a real head scratcher. In an outpatient setting, it’s less. But almost all patients have some element of mystery. Also, every patient is different, so patient X with electrolyte imbalances may be handled very differently than patient Y with the same thing. That’s where your intellectual challenge comes in to play. 


Regardless of your specialty, you’ll get challenging cases. You don’t have to be double boarded in nephrology and infectious disease (which is totally random, btw) like House to get good cases.