In medicine, contrary to common belief, it is not usually enough to know the diagnosis and its best treatment or procedure. Guidelines, checklists and protocols only go so far when you are treating real people with diverse constitutions for multiple problems under a variety of circumstances.

The more you know about unusual presentations of common diseases, the more likely you are to make the correct diagnosis, I think everyone would agree. Also, the more you know about the rare diseases that can look like the common one you think you’re seeing in front if you, rather than having just a memorized list of rule-outs, the better you are at deciding how much extra testing is practical and cost effective in each situation.

Not everyone with high blood pressure needs to be tested in detail for pheochromocytoma, renal artery stenosis, coarctation of the aorta, Cushing’s syndrome, hyperaldosteronism, hyperparathyroidism or thyroiditis. But you need to know enough about all of these things to have them in mind, automatically and naturally, when you see someone with high blood pressure.

Just having a lifeless list in your pocket or your EMR, void of vivid details and depth of understanding, puts you at risk of being a burned-out, shallow healthcare worker someday replaced by apps or artificial intelligence.

The power of knowing these exceptions to the common rules in enough detail to naturally be able to reference them is what makes a doctor a “docere”, a true learned professional.

I recently came across he term “airmanship”, which is when you intimately know your plane, the weather and the gravitational, centrifugal and and all the other physical forces that can alter your flight. Airmanship is taught in rigorous military training that brings you close to the limits of what can be done and far beyond what you will

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