Source: www.thehealthsite.com
The transition from preclinical years to the clinical years in medical school must have made many of you really excited. You feel more like a doctor, being able to examine a patient and diagnose them. Finally you got the chance to hang the stethoscope around your neck and look cool. Also, classes are not the usual boring lecture from 8 to 5 and you are going to have ward rounds and get to go into the operation theatres and clinics.
However, once you have started your clinical years, you will realise that it is not as easy, as exciting as what they show in Grey’s Anatomy or House series. Those TV shows are overrated. It is much more tedious and complicated. You have to know the correct method to examine a patient, how to elicit the signs for different systems and at the same time, respecting the patient’s personal space. And oh, not forgetting those procedures you have to do to complete your logbook like drawing blood, giving injections, setting a drip, etc. You will feel scared, not confident enough, worse you will be afraid that the patient might reprimand you upon seeing how incompetent you are.
So how do you tackle these problems? How do you prepare yourself for the clinical years and be good at it. When I was a final year student, my lecturers expect the utmost competency from their students but they will always include this line together with their instructions, “This is the time for you to learn and make as many mistakes you want.” So why don’t you brush up your skills from the beginning. Here are some of the methods I usually practice during my clinical postings:
Have a general idea on how to examine a patient
You will have a list of clinical examination books as reference. Choose one that you are most comfortable with and easiest to understand. It is alright if the book you choose is different from your friends, as the main gist is still the same. It teaches you way of examining body systems step by step. Read prior to class, even a little bit so you have a rough idea on how to do it. Nowadays, you can even go online and watch examination method from YouTube channel. The power is at your fingertips! All you need is effort.
Be confident
Be prepared mentally and focus on what you would like to do today, i.e. examine the cardiovascular system completely. Then, that is exactly what you should do. Do not contemplate. It is okay if you do not know how to do it perfectly just yet, as it comes with practice, but be sure of what you need to do. Most patients can sense that you are hesitating during physical examination. So, KEEP CALM AND DO IT STEP BY STEP. This is the time for you to learn, so do not fret!
Proper bedside manners
Before you start removing the patient’s clothes, make sure you greet them and ask for their permission first. Introduce yourself properly and smile! No one would like a grumpy doctor examining them. Ensure privacy by pulling the blinds especially for female patients. Always have a chaperon for the guys. But do not make that as an excuse for not examining a patient. Observing and examining patient yourself are two different things. Apart from that, do not forget to sanitize your hands. God knows where those pairs have been and do you know that your smart phones carry more germs than the toilet seat? Yes, it has been proven, so start using the hand sanitizer. They are there for a reason!
Practice, practice, practice
So you have learned the proper way from your lecturer. You have seen your friends do it and you have done it once or twice but you cannot seem to get it right. Well, all you need is practice. A lot of practice! After a while, the brain gets accustomed to the actions you are doing and that information will be stored in the area called basal ganglia in the brain, which helps to regulate repetitive patterned movements. Basically, when you practice more, the actions will become more automated. Practice in small groups, get your friends to comment and correct your performance. Know what is normal and what is not. If you are alone and you do not have a patient, you can use your stuffed toys as subject. As long as it helps you to practice. When there is a will, there is always a way!
Know your theory well
“The eyes could not see what the mind does not know.” Now take this seriously. If you are given a patient full of findings from top to toe, but you do not know the presenting signs and symptoms of the disease, there is a big chance you might miss it. This is because specific signs can only be seen in specific diseases. Medicine is unique. You have to correlate what you find with the theoretical bit to come to a diagnosis. This shows how mature your thought processes are. Each presentation can be explained by the pathophysiology of the disease, which is the functional changes associated with or due to the disease itself, which in turn helps you to understand the disease better. A good medical student is one who can relate their theory knowledge with clinical examination findings.
Be humble and respect one another
Among all, I believe this is the most important thing a medical student should have. The right attitude. Always bear in mind that you are dealing with human beings, with emotions and feelings. Even if you are really eager to learn but the patient shows sign of distress or reluctance, then respect their privacy and examine them another time. There are always other patients that you can examine and willing to do so. And when you have a really cooperative patient who is willing to let u examine for hours, do not be condescending. Call your friends and ask them to examine as well. Share what you know. After all, you are learning together to be a good doctor. Always respect the nurses, the medical assistants in your hospitals because you can learn a lot from these people. They know the extra tricks in doing procedures and usually they are more than willing to teach you if you have the right attitude. You are no superior to them.
I hope these points will help you during your clinical years. It takes a lot of effort to be competent. In Medicine, you have to study smart and hard. Trust me, all the hard work will pay off. As quoted by Thomas Edison, “Genius is 1% inspiration and 99% perspiration.”
Importantly, have the right attitude and you will do well.
Dr. Anis Nabillah is a house officer working in a tertiary hospital in Kuala Lumpur. She is also an editor for the Malaysian Medical Gazette.
References:
- http://www.dailymail.co.uk/news/article-2423051/How-smartphones-tablets-harbour-thousands-germs-TOILET-SEAT.html
- http://medical-dictionary.thefreedictionary.com/Movement+Disorders