The time is 9pm. It is now two hours into my night shift.
A call comes in. The nurse on the line describes a newly admitted patient who needs a doctor's review.
I reach the ward and find the patient I had earlier been briefed about. He has a chronic medical condition that is notoriously associated with excruciating pain from time to time.
He is wearing the pain rather well. He’s even smiling past the dry jokes that I am pulling (I think humour somehow lessens the blows of illness).
We had a pleasant exchange and after the history, examination and brief explanation of some of the things he sought clarification about, he asked a rather odd question.
“𝘋𝘰𝘤𝘵𝘰𝘳, 𝘸𝘩𝘢𝘵 𝘥𝘰 𝘱𝘦𝘰𝘱𝘭𝘦 𝘭𝘰𝘰𝘬 𝘧𝘰𝘳 𝘸𝘩𝘦𝘯 𝘵𝘩𝘦𝘺 𝘴𝘲𝘶𝘦𝘦𝘻𝘦 𝘮𝘺 𝘴𝘵𝘰𝘮𝘢𝘤𝘩? 𝘉𝘦𝘤𝘢𝘶𝘴𝘦 𝘮𝘰𝘴𝘵 𝘵𝘪𝘮𝘦𝘴 𝘺𝘰𝘶 𝘱𝘦𝘰𝘱𝘭𝘦 𝘫𝘶𝘴𝘵 𝘵𝘰𝘶𝘤𝘩 𝘮𝘺 𝘴𝘵𝘰𝘮𝘢𝘤𝘩, 𝘤𝘰𝘷𝘦𝘳 𝘮𝘦 𝘶𝘱 𝘢𝘯𝘥 𝘸𝘢𝘭𝘬 𝘢𝘸𝘢𝘺.”
I almost laughed but for the seriousness in the air. He also said, “𝘺𝘰𝘶 𝘱𝘦𝘰𝘱𝘭𝘦” which implied negativity.
At this moment, I am hit with guilt because I’ve done this too. I’ve let the awareness of the lack of time or urgency of the examination erase one of the most overlooked practices in patient examination: 𝗲𝘅𝗽𝗹𝗮𝗶𝗻𝗶𝗻𝗴 𝘄𝗵𝗮𝘁 𝘆𝗼𝘂’𝗿𝗲 𝗱𝗼𝗶𝗻𝗴.
During OSCEs (Objective Structured Clinical Examination) in Medical School, you would be heavily penalised if you missed simple steps such as introducing yourself to the patient, washing your hands before touching the patient, explaining what you’re about to examine (briefly) and even caring to warm your hands before coming to contact with the body of the patient! These steps may seem time consuming but they go a long way in building patient-clinician confidence as well as slowing you down so that you increase your clinical accuracy.
Do The Work: Do Not Fear!
A simple “𝘐’𝘥 𝘭𝘪𝘬𝘦 𝘵𝘰 𝘦𝘹𝘢𝘮𝘪𝘯𝘦 𝘺𝘰𝘶𝘳 𝘢𝘣𝘥𝘰𝘮𝘦𝘯 𝘵𝘰 𝘤𝘩𝘦𝘤𝘬 𝘧𝘰𝘳 𝘢𝘯𝘺 𝘴𝘸𝘦𝘭𝘭𝘪𝘯𝘨 𝘰𝘳 𝘢𝘳𝘦𝘢𝘴 𝘰𝘧 𝘱𝘢𝘪𝘯 (𝘦𝘵𝘤)” creates a strong link of communication that can encourage the patient to give more history (often remembering things they may have forgotten earlier) therefore helping you get a better idea of what’s going on.
The patient is one of your best teachers (experience is another!)
Another key thing; when results to lab tests or imaging come out, do not find it wasteful to fully discuss findings with your patient. They are eager to know what is going on (perhaps even more than you are!).
Going through this simple process helps alleviate anxiety and builds trust in your capacity as a clinician. You may not know it all, but inviting the patient into the process of treatment is crucial to your management.
A Better Me
Now this particular patient does not know this but he helped remind me of the basics that increasing knowledge can push off the cliff. He has definitely made me a better clinician.
Dear healthcare professional in training, keep it simple! It is possible!
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