Diagnosis challenge

The fourth year of medical school has definitely picked up the pace. No longer are we just supposed to tag along during the ward rounds, but instead we are expected to take on a lot more responsibilities of a junior doctor. We now need to present our own patients to the consultants, admit patients to the hospital, see our own patients during a GP placement and come up with management plans, as well as prescribe medications (which is still contingent on a doctor’s authorization).

The increase in the amount of responsibility was especially notable during our COMP 2 placement (Community Oriented Medical Practice), which involves four weeks of working at a general surgery and 4 weeks at a geriatric hospital department. I started the first half by working at a general surgery and it soon proved to be an extremely enriching experience. Depending on the wealth of the area you work at, you can truly get to see patients coming in with a great breadth of problems. From simple colds and coughs, sprained ankles, complicated urinary tract infections, somatoform disorders, to arrhythmias, strokes, domestic violence, angry patients demanding an increase in their opioid painkillers, debilitating skin problems depressions, manias and others. You really never know what the next patient is going to come with.

There are about a million things you have to be mindful of when conducting a consultation. First, you need to assess the urgency and severity of the problem the patient is coming with. You then need to realise what it is that the patient wants, as oftentimes we might be unwillingly treating a more serious problem, but one that may be not so debilitating for the patient. Furthermore, by not acknowledging patients’ ideas, concerns and expectations, patients often leave the consultation dissatisfied, hurting the doctor-patient trust but also increasing the odds of them returning because of a problem that could have been solved the first time.

While all these thoughts are going through your head as the patient is entering the room, the best advice I have received is to take it as they come. While there was a really steep learning curve, you soon start realising that there is a systematic pattern to most of the consultations. Identify the presenting complaint, get a a good story of the problem, tease out any red flags that might drastically change the management, for more chronic problems see what has been already tried before, consider if any investigations or referrals are necessary and derive a management plan.  Sometimes, however, all patients need is a reassurance, which is as valuable as a brilliant clinical judgment. The most important thing I have learned during this placement is that you should never treat the problem, but rather the patient.  Everyone is an individual with specific backgrounds and problems, and the only way to build an effective doctor-patient relationship is through understanding the various aspects of their lives.


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