What is Rathke’s pouch? What does he keep in there? Gold doubloons?
If you’re not a physician or an embryologist, there is a good chance you’ve never heard of Rathke’s pouch. However, most medical students will be able to immediately rattle off that the anterior pituitary forms from Rathke’s pouch in the fetus. That’s something we are taught, something that’s infinitely testable. Maybe a good student will remember that a craniopharyngioma arises from a little bit of Rathke’s pouch epithelium left behind.
So then you might ask a medical student, what does Rathke’s pouch look like? Can you draw me a picture? Where can I find it? If it is something only in the fetus, when is it around? You’re likely to get some blank and baffled looks. Perhaps even more fundamentally, you might ask some more deep questions. Why is Rathke’s pouch important or relevant? It is useful to know that the anterior pituitary is derived essentially from the same material as the roof of the mouth, whereas the posterior pituitary comes from the same material as the brain.
There are cellular and histological differences, but largely these aren’t really taught in any detail. As you can see, the main thing you’re supposed to learn as a medical student is to associate the terms “Rathke’s pouch” with “anterior pituitary”. This magical incantation is one of many which will give you a higher score on the Step 1 of the Medical Boards. It has a bit of the feeling of phonetically sounding out words to a prayer in a language you don’t understand as a way of getting into Heaven.
The writings (or really transcripts of the stories) of the physicist Richard Feynman have been hugely influential on my thinking of just about everything. He has a wonderful bit to say about the very important difference between knowing the name of something and actually knowing something about it:
The video is less than 2 minutes long, go watch it, I’ll wait. If you get distracted and start watching some of the other great clips, nothing could make me happier. This one for example is one of the best descriptions of the scientific process. However, getting back to Rathke’s pouch, this is just one example of the general problem of creating a sense of knowing without really understanding. For example, Idiopathic is one of the words that physicians use that I can see no more use for than to trick themselves and their patients into thinking they know more than they really do.
Luckily, I received some very good anatomy training. Where we had to answer questions not just on the names of things but on their important relationships and how they interacted. If you’re going to stick a needle into someone, then you should know what structures lie underneath and what will happen if you likely puncture them (upstream and downstream). For example, why can puncturing the eardrum making you lose a sense of taste?
However, the problem with Rathke’s pouch, is that in some sense it is empty, empty of meaning and real understanding. A problem with medicine is when we trick ourselves into thinking we know more than we do through words.