Some things can only be learned from experience, but I have always been a strong believer in the value of studying for exams. This is why I am spending so much clinic time lately dealing with imaginary patients.
I should explain: my clinic is currently looking to hire several new doctors from out of sector. This is something that has caused problems in the past. New clinicians arrive from light years away, bringing impressive lists of publications and achievements—and staggering ignorance of the medical issues we face in this part of the galaxy.
This time, I have devised a number of clinical scenarios for distribution to everyone involved in recruitment. For example:
SCENARIO: Pubescent juvenile with history of life-threatening Eridanian pulse allergy. Patient presents with recurrent, severe migraines and intermittent episodes of precognition with heightened athletic ability.
The job applicant is supposed to consider the scenario and render a professional opinion. Can a reliable diagnosis be made based on the facts available? Are further tests required? If so, which ones? In this case, many doctors will take the scenario to be a lighthearted reference to our system‘s famous Planetary Messiahs and will give a response like “Patient appears to be in the process of becoming a galactic hero. Suggest contacting Messiahs‘ Academy to arrange a full assessment.“
But those doctors who note the detail about pulse allergy and who have been keeping a proper eye on the local literature will be aware of the recent discussion about the so-called “God that Failed“ syndrome, reportedly caused by the drug cocktail most commonly used to treat life-threatening immune disorders briefly magnifying, then burning out, extranormal abilities in patients. These doctors will recommend prescribing a different allergy treatment and monitoring the patient‘s symptoms for a few weeks before contacting the Academy.
A number of the scenarios contain tricks like this. But of course it would be no good for them all to be the same, so I have also included several like the following:
SCENARIO: Early-30s human in previously good health, recently returned from suspended animation long-haul trip through the Rosette Nebula. Patient has been experiencing low energy, involuntary teeth-grinding, insomnia, loss of appetite and other malaise.
This would seem at first to be straightforward. Mild depression is common in these life-lag cases where the traveller has aged only a few months while several years have passed for their friends and family. In that case it would be appropriate to order a basic blood workup and refer to cognitive therapy. But there is also the reference to the patient visiting the Rosette Nebula. All the symptoms mentioned have been observed during the incubation phase of infection by the Rosette Mind Virus, before the more frightening behaviour and personality changes that come later. Is that worth pursuing?
My answer would be a firm “no.” It has been twenty years since the last confirmed case of Rosette, and since all the tests for the virus carry a significant risk of brain cancer I would look very unfavourably on a doctor who suggested investigating that as part of their initial approach.
My scenarios fall into three categories. Some are sly tricks. Some are double bluffs, where the obvious explanation is the most likely one. And then there is a third, more straightforward, category, designed to call attention to problems we encounter in this clinic that are not widely known about elsewhere.
But sometimes things are unknown for a reason.
A short time after submitting my scenarios to the administrative department for onward distribution I had a visit in my office with a couple of goons—really, that is the only word for them: bulky, blank-faced tools of authority. They told me there were some problems with my work.
“What is meant by this scenario?“ one goon said, prodding at a printout. “What‘s the diagnosis?“
“It‘s a differential diagnosis,“ I said. “The patient‘s affliction could have any number of causes.“
“Which one did you have in mind?“ The goon’s breath was in my face. It smelled like a lifetime spent consuming nothing but protein shakes and chewing gum.
Through barely gritted teeth I said, “What I had in mind was a number of patients I have seen over the past year with case histories similar to this.“
“These symptoms,“ the other goon said. “Are you aware they are associated with exposure to highly illegal biological weaponry?“
“I am not an expert in the law,“ I said, “only in treating the sick.“
They gave me their card and left. Once they were gone and my heart rate had returned to something approaching normal I dropped the card out of sight, into a file marked “Hazardous Organisms.”
The following day, I was informed that one of the clinic‘s most important sources of grant funding was under review. Then a major medical supplier called to cancel their regular shipment, saying there was a shortage.
“Of what?“ I asked.
“Everything,“ they said.
So I fished the card out of the file, called the number and said I had thought about the problematic scenario and realised it could be improved by adding several additional symptoms, which happen to be more in line with a diagnosis of boring old Human Herpesvirus-20.
“And the bit where it says the patient just got out of the army?“
“Only there for narrative colour,“ I said. “I‘ll remove it.“
This week our grant was restored and shipments of clinical supplies are back on schedule. And details of ex-military patients showing clear signs of having been exposed to forbidden biological weapons have simply become one more item added to the list of things we take new doctors aside and inform them about, far from interfering eyes and ears. I have always been a strong believer in the value of studying for exams, but some things can only be learned from experience.