Interns and medical students are notorious for jumping on the "zebra" diagnoses when they see routine patients. Differential diagnoses for uncontrolled blood pressure always include pheochromocytomas or renal artery stenosis, and Tb is inevitably brought up as a possibility on any given pneumonia patient.
So when my intern, on his second day on the wards walks out and says "That patient has acromegaly" my knee-jerk response as their older, wiser upper level was "No they don't."
Except.... they did have rather large hands. And feet. And they looked... well, acromegaly-ish. So I asked to see a driver's license.
The picture from five years ago revealed the subtle change over time - not enough that anyone who saw the patient on a regular basis would notice but I could definitely see the textbook "coarsening" of the facial features.
And so, I sent him off to figure out what tests he wanted to order, and put in for the TSH, cortisol, prolactin and IGF-1 off the list he brought back for me this afternoon, with the promise of a free cup of coffee - (the real kind, from the coffee shop in the patient waiting area) if the diagnosis was real.
While the patient's (totally unrelated) diagnosis has responded well to routine treatment, with a planned discharge monday morning, the CT head we ordered for confirmation just came back "enlarged pituitary, question mass."
Guess I owe the kid some coffee. :)
It's a small price to pay to watch a fledgling physician experience the thrill of a great diagnosis for the first time; seeing it reminds me of why I want to go back into academic medicine eventually. There's a certain satisfaction that comes with practicing effective, thoughtful and compassionate medicine just by yourself - but being part of the training to make someone else into a great physician is a reward beyond measure.