I’m in the most precarious time in my career. Beyond mid-career, I have lots of experience. On some level I think I have it figured out. The day you have it figured out is when you should be nervous.

John Mandrola’s tagline on Twitter says ‘the more you see the harder medicine gets.’ He’s knows. He looks closely.

Medicine is easy when you don’t look hard. This is the double edged sword of experience. Alot of doctors who stop looking at mid career. While consistent repetition has its place, comfort zones can be dangerous. The trick is to surround yourself with people who challenge your assumptions and push your limits.

There was the second year medical student who made the diagnosis of acute intermittent porphyria in a child with recurrent abdominal pain (a once-in-a-lifetime diagnosis). When asked how he made such a brilliant diagnosis he quipped, “what else causes abdominal pain?”

Young or old when you don’t know any better medicine is easy.

Image modified from page 251 of “Leçons sur l’exploration de l’oeil : et en particulier sur les applications de l’ophthalmoscope au diagnostic des maladies des yeux” (1863). Francis A Countway Library of Medicine via the Open Knowledge Commons and Harvard Medical School.