One of my reproductive pathophysiology professors wanted to hammer home the fact that the clinical cases that present to us in practice will not always mimic those that we see in lecture slides or read about in the Merck Veterinary Manual. The quote implies that we are not infallible even if we theoretically know microbial pathogenesis like the back of our hand. Bacteria, though they can do a lot of damage, do not read up on how to infect their hosts. (They may, however, do so in a Gary Larson comic.) Rather, we read up on them. It is necessary to understand that when creating a list of differential diagnoses, we should not exclude a particular disease simply because a few clinical signs associated with it are absent. That could be a recipe for failure since the actual disease could be A, but we may treat for B–unsuccessfully.
One of my best friends in college would frequently wear a University of Chicago shirt that read “That’s all well and good in practice…but how does it work in theory?” It always would get a chuckle out of me, but one thing that is not nearly as funny is the prospect of the converse being true when I start working as a vet. What if “that’s not all well and good in practice?” What if all the microbiology and pathology courses I am taking are for naught? To assuage my fears, I just have to understand that much of what I’m learning will indeed be applicable, much of it will inevitably be forgotten, and over time I will be able to get better at creating a list of differentials and make sure not to rule out anything too early.