General pointers in clinical work

 

 

1.      Be nice.

a.      Doctors – no not just your Professor tutor. You’ll need to page him to see him. Many a time the ones who guide you through the more immediately-practical things are the HOs and the MOs.

b.      Nurses – well, if you’re the officer cadet, they are the sergeants. They know the men (ward patients) much more than you do, puny cadet! So treat the nurses with respect, especially the sisters (warrant officers).

c.       Patients – this is fundamental. Many times in typing this document I have used the word “cases” when I should have used “patients”, but I’m just trying to be objective. Patients are people whom you’re hoping to learn from. True you are entitled to an education by paying your fees, but you are not given the right to intrude into the patients’ lives. It is a privilege. Respect that.

d.      Fellow medical students – Your fellow classmates shares and clerks cases with you, your seniors know which short or long cases to see, and your juniors reminds you of the zesty medical student you are behind that fatigue. And the list goes on…

 

 

2.      Be responsible for your own learning – Be proactive.

a.      Doctors are busy people – acknowledge that. If you don’t ask, you will never find out. Ask to be brought through procedures, topics etc. Arrange tutorials pro-actively.

b.      Be active in doing procedures, within patient-comfort limits. Once you’re good with taking bloods, help the busy HO with these chores. It’s a win-win situation – you help him, he has more time for you, and you learn more about his job (which will be your job in time).

c.       Every morning there are ward rounds.

                                                               i.      If you are expected to turn up, don’t be late. If you can’t be there let someone know.

                                                             ii.      Ward rounds are useful only if you know the patients’ presentation and condition, so update yourself on/ clerk the patients of the team you’re attached to.

                                                            iii.      Try not to just stand there and do nothing. I spent a great deal of time in my first posting just doing that. Ask questions (tactfully), pick up the stethoscope to listen to the lung fields and heart sounds, help with the recording in the case notes etc.

 

Text Box: FAQ: What are ward rounds? Every day there are ward rounds when the whole team of doctors (consultants to HOs) will see their patients together. During rounds, junior doctors update the senior doctors and the senior doctors give advice. This can happen a few times a day, most often in the morning and the afternoon.   Who’s in who’s team and who are their patients? The doctors of a department work in teams and each team usually has consultants to HOs. Each day there will be a team “on take”, meaning the patients who come in on that day will be primarily handled by the team.  If the patient has a condition better handled by another team of a different specialty, the patient is referred to the other team via a “blue letter”. Similarly, your team will receive “blue letters” (referrals) as well.   So what’s Grand Ward Round, Hospital Round, General Surgery Round etc? The word “rounds” is used rather extensively. The following “rounds” are usually held weekly. Grand ward rounds are in my words large-scale ward rounds, usually held within the department, and can involve HODs and more teams than one. Departmental rounds e.g. General Surgery, Radiology etc are held by some departments either for patient case discussion, or teaching sessions. Patients are not involved physically. Hospital rounds are held on a hospital scale, whereby staff from the whole hospital can choose to be involved. The distinguished speakers talk about a topic, somewhat like a seminar. M&M rounds are not sweet at all. Mortality and morbidity rounds are for the doctors to bring up patients who have suffered complications or passed on.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.      Although many of the rounds in the departmental and hospital levels are targeted at staff, they welcome you too! If you’re interested and can handle the topic, go ahead!

 
 

3.      Be well-equipped

a.      The instruments you should have available:

                                                               i.      Stethoscope, tendon tapper, tuning forks, pen torch.

                                                             ii.      Ruler and retractable measuring tape – ruler for small lesions and tape for abdominal girths.

                                                            iii.      Clothes peg – to hold up the shirt of the patient during examination.

                                                           iv.      Alcohol swabs – for your instruments. Can get from ward.

                                                             v.      [Neurology] tooth-picks, tongue depressors, cotton balls etc… some can get from ward.

b.      Quick references – be it handbooks or electronic devices.

c.       Your notebook and attire (duh…)

Text Box: FAQ: Do I really need to carry everything around? Well, perhaps not all the instruments in everyday clinics.  In time, you will know what are needed. For example, in GS I hardly used (and soon didn’t bring) tendon tappers and tuning forks, let alone the neurology tools.

 

 


 

 

 

4.      Don’t forget about the other stuff…

a.      Log books

                                                               i.      From GM/GS onwards, you will be given a logbook. For every posting, each logbook is for you to document what cases you have seen, what procedures you have done, seminars and lectures attended etc…

                                                             ii.      More about filling in the logbook is discussed below.

 

b.      Write-ups

                                                               i.      Most postings will require you to write-up on a patient and his condition. The number of write-ups and their length is dependent on which posting and which hospital you’re posted to.

                                                            ii.  Generally, write-ups require you to write about relevant points in the history, physical examination, differential diagnosis, investigations, treatment, and finally discussion of the case. Approach your tutor to ask about what he expects in the write-up. Importantly, write-ups need to be logical. 

                                                           iii.   It’ll be good if you can find a senior who has a “model” write-up from which you can reference the format from.

                                                          iv.  Don’t leave your write-up to the last minute of your posting. Find a good interesting case to write on early.

                               v.  More pointers for write-ups found in a later section.

 

c.       Clinical assessment and tests

                                                               i.      Assessment can be in the form of logbook assessments, write-ups, clinical tests, theory (MCQ) tests.

                                                             ii.      For clinical tests, testers are not out to fail you. As long as you’ve been responsible for your education you will do fine. Com’on! We’re all (rather) smart people.

1.      Long cases generally require you to spend more time with the patient to take a rather elaborate history and physical examination, present to the examiner and discuss the differential diagnosis etc. He/ she will also ask you related questions.  For example, Cor pulmonale secondary to COPD.

2.      Short cases generally require you to spend less time with the patient in a perhaps more directed manner. For example, examination of a lump in the neck.

                                                            iii.      General examination tips apply – be well dressed, relax, get there early, be confident, introduce yourself to the patient and build rapport etc.

 

Index    Overview of M3    Basics    General Hospital Layout    General pointers in clinical work   

Main Objectives of the various postings    Books      Case Write-ups    Presentations

On-line resources    General Tips for Exams    Ethics

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