“I wish I could play little league now. I’d be way better than before.”

—Mitch Hedberg

I believe Mitch Hedberg said more truisms in his short life than 99% of humans on this planet. This is a gem and goes right to what I want to talk about. Experience. Please notice I didn’t call it wisdom; I’m not talking about a deep philosophical approach to getting old (which I am) but making a more directed observation. Seeing things over and over is a great way to learn. I write this at the end of another academic year; another group of residents off to become fellows or staff somewhere. Another group of fellows off to become worker bees somewhere (or do another fellowship). This is a time of some modest reflection.

Here’s the gist of it: early in your career (and for the sake of this piece, let’s pretend that you’ve completed training and you are the ATTENDING now, in private practice, an academic shop, whatever). Okay, so you’re working. You’re sitting there, pulling up cases and making with the words. And you’re killing it. You are awesome . And then you open a case, and…you have absolutely no idea what you’re looking at. You quietly hyperventilate and sip some more coffee and look again, except nothing changes. It still looks like whatever, and you have no earthly idea what it is.

Early in your career, I’ll tell you exactly what goes through your head—you have no clue if this is truly a weird case, or you are just a moron. It can shake you in ways you didn’t imagine could happen. So, you page Dr. Google, or open a teaching aid you know and love, or maybe grab a partner/colleague—one with gray hairs and a few years. And, usually, they have something for you. And you recover until the next one. After a few years, you might see another case like this, but the next time you’ve got some muscle memory, and you remember! Well, hopefully. Experience is like speed. You can’t teach it.

Experience matters in another important way. Perhaps more importantly than just having seen those oddities of life, you now know what to ignore. I like to have people point out to me that I didn’t describe some meaningless, incidental thing . I choose to ignore those; that way I don’t scare patients and waste my time. Feel free to describe and measure those pineal calcifications or measure those normal lymph nodes; have at it.

So, I guess I won’t be able to go back and play little league ball again (although I would absolutely kick ass this time), but I do have some experience, and I know a few things. I won’t waste too much time on incidental nothings, and I will likely know one or two of those weird cases, or at least be able to give you a great differential. Maybe I’ll join you in that quiet hyperventilation and search for more caffeine.

Keep doing that good work. Mahalo.