We had a very interesting bed side teaching session with fourth year medical students this week. To be honest, all bed side teaching sessions are interesting, it is only the lack of time to write and reflect about things.
There we were, in the doctors office, and only one student had a patient with positive physical findings. After much ‘training’, the students have become better at not divulging information before it is asked for.
A respiratory case, the student said.
Boring, I thought.
Well, I was wrong.
After spending some time in the general medical wards, most medical students will have encountered the ‘usual suspects’:
- Acute coronary syndrome or those admitted for investigation of chest pain
- Heart failure
- COPD, asthma, acute or infective exacerbation
- Renal failure
- Liver cirrhosis
And the list continues.
Those are the common, (and sadly, most are preventable to a certain degree) general medical conditions.
While it may be ‘boring’ for the lecturer, the students are expected to see these cases and present/discuss them all the same. The more common a condition, the more a student is expected to have in-depth knowledge of the disease, its management and complications.
(I feel compelled to write a note that recently, in a long case bed side teaching session, I was amazed at how the students were unfamiliar with asthma management, asthma being a very common medical condition in general medicine, primary healthcare AND paediatrics).
So we arrived at the bed side and the patient agreed to be examined. YAY!
I went to a quiet corner with the ‘student doctor in-charge’ (the student who had clerked the patient).
The student, (most of them would), attempts to tell the whole story. I cut the student short:
‘Bronchiectasis, infective exacerbation’ came the curt reply.
“There’s clubbing?” I asked, skeptical at first, glancing at the patient from afar.
‘This will be interesting’, I thought to myself. So far, this is the first case of bronchiectasis that I have encountered this year for bed side teaching, with this group.
We picked a student volunteer and the instruction was:
“Examine the respiratory system”.
I must say the student was a good student and did most things well.
Here are some tips:
If after examining the hands, you notice it is pale (pallor of the palmar creases), warm, and there is clubbing. It’s best to present it this way:
“There is stage four clubbing, pallor of the palmar creases and warm, sweaty hands”, instead of saying “The hands are slightly warm, there is pallor and clubbing”.
And the reason behind that is, that clubbing usually signifies serious underlying disease where as the other findings may turn out to be insignificant.
But I’m glad that the student picked it up.
To be continued as baby has woken up.