Many courses we have taken in vet school could do a better job at hammering home the way we approach clinical cases. Often, we are given a list of possible causes for a disease, the clinical signs that an animal may or may not show, lab tests that can be done to diagnose the disease, and possible treatment options. While this is fine and well, I feel as though there is a lot of “what to do” in the case of A, but there is, in my humble opinion, not enough of the “why” we do it.
Clinical Dermatology has stood out from the crowd by answering the latter. It has probably been my favorite class thus far because it defies the norm of simply listing clinical signs associated with various diseases. Our professor makes a point of helping us identify and define cutaneous lesions and understand well the disease etiologies. He has instilled within us the avoidance of exclusively using the “clinical eye” to diagnose patients. While pattern recognition is most definitely a useful tool employed by clinicians, it should most definitely not be the ONLY method of assessing animals who come into our care. Even if a severely pruritic dog comes into the clinic scratching incessantly and showing lesions characteristic of sarcoptic mange on their ears, elbows, and abdomen, a clinician should not immediately jump to conclusions and diagnose the dog with scabies. It is quite possible that said dog is indeed suffering from scabies, and the vet can add scabies to the top of his or her list of differential diagnoses, but a problem-oriented approach is an ideal way to handle cases.
It is a beautiful combination of our subjectivity for spotting clinical signs and the scientific method using a series of diagnostics to rule out other possible diseases. The facts I have learned in Derm and, just as important, the way to tackle cases, will hopefully serve me (and my patients) well in the future.