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Vet School Episode Third Year – The Return of Common Sense

Another title could have been "Third Year - Finally a Year in Which I Can Excel."

Now, before I get too far into this post, I must explain that common sense is a part of every year of vet school.  However, as a student, common sense can appear lost during the first two years as we get into the weeds of microbiology, pharmacology, and parasitology.  As a 30,000-foot, big-picture-kind-of-guy, all of this memorization left me floundering and looking for some semblance of order.   Well, thanks to third year, I found it.

First year of veterinary school is about learning normal - normal anatomy, normal physiology, normal embryology, normal histology, normal, normal, normal.  Which makes sense because if you can't identify normal, you will never be able to identify abnormal.  Enter second year.  Second year is about identifying abnormal and learning the fundamentals about ways to treat the abnormal.  Third year is about putting it all together in the classroom and laboratory setting.  Medicine, radiology, and surgery courses are set up in a disease centric fashion.  What does that mean?  In each class, we take a problem or a disease and learn the symptoms, diagnostic tests, and treatment options.  Most of the classes divide the disease based on system.  For instance, we will study all of the major small animal gastrointestinal diseases at one time before moving on to anther category.  I love order!

In third year, we also get to play doctor.  One of the toughest, but in my opinion best, classes, in the entire vet school curriculum is third year clinical correlates.  Early in the week, we get a case, usually based on a real case seen in the clinics.  The case includes some combination of patient and disease history, physical exam findings, and blood work, but not always all three.  Then we have to identify the problems (much harder than it looks), come up with some differential diagnosis, create a diagnostic plan, and, if indicated, come up with treatment plans we would start immediately.  And then, we sit together in class and a professor calls on us and forces us to explain why we made our decisions, right or wrong.  This is the closest we have come to thinking like real veterinarians, and it is exciting…..and scary.

How does common sense come into play?  Well, lets say you suspect a cat has liver or kidney disease.  The best way to test for either one is probably a biopsy.  However, would you really want to poke the poor cat that just walked in the door before doing blood work?  Heck no!  For a simple little mind like mine, this common sense, orderly approach is so refreshing and comforting.  Now the class is fraught with challenges, and doesn't exactly mirror real life mainly because there is a set of "rules" that must be followed.  The rules, though, are in place to get us to focus on the diagnosis and treatment plans, and not whether or not our tests are lying to us.  And trust me, those tests will lie to you in practice.  Just ask your favorite doctor or veterinarian.  But, that is also where common sense comes into play.  If you have a perfectly healthy looking animal standing in front of you and the blood work comes back with abnormalities that are only found in dead Martians, common sense states that you probably have a problem with the machine or the sample, not the patient.  What do you do?  Run it again.

This reintroduction of common sense approaches can be hard after spending two years focusing on theory and possibilities instead of reality and probabilities.  Trust me, every year and every class is important, even though my colleagues and I have all said differently at some time, but this return to clinical, common sense approaches may be the most important.  Third year is tough, challenging, and exciting.  We are making the transition from book to fur, theory to real life.  We are playing doctor because very soon, we will be doctors.

One final note, how 'bout that Johnny Football!!