I’ve finished three of my clinical rotation in veterinary school so far: molecular biology, soft tissue surgery, and anatomy. This past Monday it was time to switch over to #4, which is dermatology. The only thing keeping me from having a panic attack was having heard that this was a fairly laid back rotation; I am far from an expert on this subject.
It’s like…bones, right?
Over the past week I have managed to relearn quite a bit of what I forgot from my dermatology class last year, but it’s made me think a lot about an interesting perception the public has about doctors. I think that most people feel that doctors just know everything; that we all remember every aspect of every disease and drug out there. I want to assure anyone reading this that that is not the case. Doctors are constantly looking up information. There are simply far too many medical facts for anyone to remember them all.
All my 50 minute lectures from Dermatology last year.
I mean, look at all those different diseases up there. And that’s just for dermatology. We’ve also had lectures about pretty much every drug under the sun, cardiology diseases, cancers, how to repair various bone problems, digestive diseases, surgical procedures, not to mention every muscle and nerve in the bodies of half a dozen different species. And that’s all the tip of the iceberg; there’s plenty more topics we’ve gone over.
The point is, it’s physically impossible to remember all of that stuff. This means that in clinics I spend a good half my time desperately going through my course notes for diseases that I can barely read.
So if that’s the case, what do we actually learn and remember from vet school? Since my first year at MSU, I’ve come to believe that the most important things we are taught are the basics. That is to say, I know how the body works well enough that I can understand my other notes. I can easily tell you an animal’s major bones and muscles, name a handful of the most important drugs we use and what they do, the flow of blood through the body, the basics of our immune systems, etc. But go beyond that? Now I need to grab a book.
Though for some reason I still can never remember why vets act like steroids are miracle drugs half the time and the most dangerous poisons on Earth the other half.
So just realize that whenever you go see any doctor, they don’t know absolutely everything off-hand. Obviously after years of practice they’ll easily recall the details of the most common diseases they see and the dosages of the most prescribed drugs, but there’s nothing wrong with hearing that your doctor had to look something up before explaining it to you. Just be glad that they have the background knowledge that is necessary to translate a medical textbook into something remotely understandable.
Unsurprisingly, it did not take long to find something completely insane in Plumb’s Veterinary Drug Handbook.
So with that long tangent out of they way, how has dermatology been so far? I like it, although it’s definitely a lot different than my last rotation in the hospital. No matter what reason see you an animal for, you need to take a good history and physical exam. But my last rotation was soft tissue surgery, which meant we usually had a really good idea of what was wrong with the animal and had a surgical plan to fix it. That meant both the history and physical exam were downplayed. In derm, though, those are the two most important things we need to do by far. Considering that I’m still new to doing my physical exams and talking to clients, it definitely got a little nerve-wracking.
My first few patients this week I missed some major things. I forgot to look at the axillas (armpits) and failed to notice alopecia (hair loss), I neglected to write down some hypotrichosis (hair reduction / loss), and I didn’t ask nearly as many questions as I should while getting the history from the client. That was all disheartening, but what brought me closest to a panic attack was getting cytologies (microscope slides of tissues) ready and handing them to the doctor. She told me to go read them, and I just stared blankly at the microscope for about ten seconds.
My old nemesis.
I hate anything to do with microscopes. They hurt my eyes, I can never get both eyepieces to fill my vision perfectly, and I can barely remember what any pathogens look like.
What are those things?! Let’s just say bacilli and neutrophils.
Luckily all the doctors and technicians in the dermatology service have been extremely helpful so far. The resident in charge of us students told me the basics of what I was supposed to do (turns out I had to look for things) and the technician sat with me and showed me what yeast and bacteria looked like. This all ties into what I mentioned before; I’d learned all this during second year, but after not touching a microscope for a year and a half I completely forgot everything except how to actually use the darned thing.
But after my first week, I do feel like I’ve learned and experienced a lot. I have gotten a lot more practice in looking at slides and can somewhat reliably pinpoint yeast, cocci, and bacilli. The rotation’s resident sent me a wonderful email telling me that my discharges have improved a lot since Monday, I’m asking good questions, and I’ve shown that I’m doing research on my own. I’ve definitely refreshed my memory quite a bit on two of the most common dermatological diseases: food allergies and atopic dermatitis (environmental allergies.) I even got to restrain an animal and watch the technicians give an intradermal allergy test, which was really cool.
Want to know what your dog is allergic to? Knock them out, shove 50 different substances into their skin, and see what they react to!
I definitely feel hopeful about next week; if my myriad of failures the past 5 days earned me a lovely email, I’m pretty sure I can become valedictorian now that I have some idea of what I’m doing. (Just kidding, that will literally never happen.) But I’m definitely glad I picked derm as one of my elective rotations; it’s something that I’ll have to deal with a ton in private practice and it’s definitely interesting putting all the pieces of the puzzle that the owner gives you together.
Oh, and one last piece of advice for any current or prospective vet students reading this. When you get into clinics, just show up, have a good attitude, and look up at least something about the diseases you suspect your patient may have before you talk to the clinician. If that’s all you do, you’re pretty much guaranteed to pass.
Ryan, promoting the easy way out since forever.