The Medical Student Diagnostic Dilemma

By Sinead Murphy

As a second-year medical student, fresh out of our first cardio clinical skills tute – I used my shiny new Littman to listen to my own heart. Almost unsurprisingly, I heard a murmur.

This is a common story, so much so that a ‘Grade 0 Heart murmur’ has been jokingly coined as a murmur only a medical student can hear. But the difference was, this heart murmur didn’t go away as I listened to more and more normal chests. It didn’t go away when I watched heart murmur video after heart murmur video on YouTube. It still didn’t go away when friends reassured me that they were pretty sure it was normal.

Finally, I visited a GP, and without listening to my chest she told me to stop being an anxious medical student, and to never do examinations on myself. A couple of months later, a much more understanding GP, an echocardiogram and a cardiologist later, it was confirmed that I had a bicuspid aortic valve, and an (admittedly benign) flow murmur.

A close friend of mine woke up in the middle of the night with pleuritic chest pain and an impending sense of doom most of us are lucky enough to have only experienced in the ‘Presentation’ section of BMJ. In the ED, her doctor told her that although he would order a scan, there was no way she had a PE because after all, a clinician’s judgement is the best diagnostic tool. His clinician’s judgment must have a NPV of <100% as she indeed did have a PE, requiring months of management.

Despite being in a course where so much emphasis is placed on us becoming non-judgmental, non-biased doctors, as a medical student I often feel the need to hide what I study when visiting a medical professional. It seems that my answer to ‘what is your occupation’ somehow automatically leads to a number one DDx of hypochondria.

“Despite being in a course where so much emphasis is placed on us becoming non-judgmental, non-biased doctors, as a medical student I often feel the need to hide what I study when visiting a medical professional”

In my third year of medical school, I slowly became more and more convinced something was wrong with me. What seemed to come so easily to everyone else seemed near impossible. I couldn’t comprehend how my peers were keeping up with matrix conditions when I couldn’t seem to even start. Forcing myself out of bed on a Wednesday morning felt like torture, enduring a lecture I felt I would never be able to take in the same way as the people sitting around me.

I had the overwhelming sense that I would never be able to reach my goals in medicine- despite a genuine drive and passion to do so. With this constantly in the back of my mind, the days got progressively harder, and the idea of going into hospital would fill me with dread. The upside to all of this was it was great learning for depression and anxiety in 4th year psych. The downside, I suppose, was the depression and anxiety.

I went back to the second GP, the one who had listened to me stress about my heart murmur, and who had at the time told me that “even as a medical student I deserve to have all my concerns listened to and investigated”. He gave me a referral to a psychiatrist half-way through third year. But it took me another year on top of this to even book an appointment. The constant med-student jokes and dismissals had so deeply damaged my confidence that I convinced myself I was making it all up. Surely everyone feels like this. You’re being dramatic. Stop looking for excuses to not study. It’s near impossible to trust your own sense of judgement when it feels the whole world disagrees. Two separate psychologists told me I just needed to put less pressure on myself. I felt no one was really listening. Was it unreasonable to want to be able to listen to just one lecture? To finish even one matrix condition?

Midway through my 4th year, I was diagnosed with ADHD. Now that it’s being treated, the idea that I had convinced myself I was making it up is diabolical. Currently, I live a life unrecognisable to my past one. I feel equipped and motivated to face the infrequent challenges that may come up during any given day. Fighting paralysing anxiety just to get out of bed used to be a daily challenge I accepted as normal.

“Fighting paralysing anxiety just to get out of bed used to be a daily challenge I accepted as normal”

Mostly things are great, but I still come across gaps in my knowledge, clinical skills that I never learnt, and wonder what could have been if I’d gotten that diagnosis a year earlier. Or two. Not a particularly productive train of thought, but it certainly makes me want to talk about it in case someone out there is feeling the way I was. Or even if it’s not you, but your friend, or someone in the year below. They teach us about different types of bias, so let’s not forget about this medical student diagnostic dilemma.

Because even as medical student we deserve to have our concerns listened to and investigated.


If you are feeling anxious or worried about yourself or a friend, please reach out to:

– A trusted support person, friend or mentor

– MUMUS representatives for your year level

– MUMUS Community and Wellbeing

– University support [available to metropolitan, rural, & international students] – philippa.corby@monash.edu, jodie.vickers@monash.edu, or call ‘1300 STUDENT’ (1300 788 336)

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