Medical Studentitis

A little knowledge can make us vulnerable

Medical students have the luxury of looking up our vague and unexciting symptoms not only on Google, but also the British Medical Journal, Up To Date, and our own dog-eared copies of Harrison’s, Talley & O’Connor, or Robbins & Cotran which offer up a sizeable list of (variably far-fetched) differential diagnoses.

Additionally, medical students are positioned halfway between layperson and doctor on the “health literacy” spectrum. Our background knowledge of anatomy, physiology and pathology allows us to identify a likely mechanism connecting a symptom to a disease process. Thus, most medical students (hopefully) won’t trust Doctor Google’s assertion that their mild back pain is the first sign of a burgeoning spinal abscess. But at the same time, medical students do not have the same depth of knowledge and experience as a seasoned clinician – to know what is likely or unlikely, common or uncommon, in a particular patient. It is this incomplete knowledge which leaves us vulnerable to medical studentitis.

For example, a medical student friend of mine experienced a weeklong constant headache associated with blurred vision. She was convinced that her pain was the first symptom of a brain tumour, suspiciously like a patient we had seen on the ward together earlier that year. Needless to say, her GP was not impressed when she demanded an urgent MRI of the brain.

Overall, medical students are known to be a fairly anxious group. With a limitless amount of knowledge to absorb in a mere five to six years at university, our baseline anxiety is quite high. It’s also known that anxiety and depression affects medical students and health professionals disproportionately. It follows then that medical students could be at risk of health anxiety, just like anyone else.

Medical students don’t always cry wolf

Another medical student friend of mine woke up one night with severe abdominal pain. Instead of presenting to the Emergency Department (ED) like any rational person would have done, he instead intellectualised his condition. “It’s not REALLY right iliac fossa pain,” he rationalised, “so it’s unlikely to be my appendix. I’ll just wait. I don’t want to look stupid presenting to ED if it turns out to be nothing.” Five hours, ten vomits and an ambulance ride later, he was diagnosed with acute appendicitis and operated on the next day. In this manner, medical studentitis, or fear of being labelled with medical studentitis, can deter medical students from seeking medical attention when it’s actually needed.

I’ve personally experienced both sides of medical studentitis. During the second year endocrinology term, I came across a case study with symptoms that seemed more than coincidentally similar to some of my own medical problems at the time. I went to see my GP and confidently pitched my self-diagnosis of polycystic ovarian syndrome (PCOS). I was sent home with the diagnosis of “medical studentitis”, as the GP explained I was studying the disease at the time and some of my symptoms didn’t quite fit into the typical pattern of PCOS. However a few years later, when revising endocrinology again for my finals, I became convinced that my earlier diagnosis of medical studentitis was wrong. I asked for a second round of investigations – funnily enough, the diagnosis came back as PCOS!

A patient’s perceptions are worth exploring

When we look at models of health care, GPs are expected to explore the ideas, concerns and expectations of patients. I believe the patient’s perceptions – or in this case the anxious medical student’s perceptions – of what might be causing their symptoms are useful and worth exploring. However, practitioners do need to take care when a patient presents with a pre-formulated diagnosis which they simply want confirmed.

For this reason, I don’t blame my doctor at all and I respect his clinical reasoning. After all, the hundred other times I had presented with vague symptoms “just in case” was quite sinister, so his diagnosis of medical studentitis was spot on.

Don’t be daunted by medical studentitis

Medical studentitis is an interesting phenomenon which I suspect fades away as one’s clinical knowledge improves. Nonetheless, if you find yourself preoccupied with your symptoms or really worried that something is wrong, you should certainly seek medical advice – if only for your own peace of mind. Anyway, I’m off to get this cough checked out. I have a feeling it’s lupus!

Lana Nguyen
Final Year Medical Student
Western Sydney University

References

1. Collier R. Imagined Illnesses Can Cause Real Problems for Medical Students. Canadian Medical Association Journal. 2008 Mar 25;178(7):820.
2. Waterman LZ, Weinman JA. Medical Student Syndrome: Fact or Fiction? A Cross-Sectional Study. JRSM open. 2014 Feb 1;5(2):2042533313512480.
3. Azuri J, Ackshota N, Vinker S. Reassuring the Medical Students’ Disease – Health Related Anxiety Among Medical Students. Medical Teacher. 2010 Jul 1;32(7):270-275.