My first clinical experience

[Probin]

As I wait for my MBBS II year result to come, I spent the past weeks or so diligently practicing clinical skills assessment at the Helping Hands Clinic. Thus far in medical school I’ve only spent time with books learning diseases and its process, but I’ve never been given the opportunity to see the patient.

At the Helping Hands Clinic I sat next to the doctor who happened to be the pass out from KMC. I watched keenly, what he was doing and writing. After his 6th patient he asked me if I wanted to see the patient as well. I said sure, but had no idea what I was gonna do. I sat on another table across from the doctor and he handed 5 patient tickets.

I prepared myself, however, when the patient approached me, I suddenly became overwhelmingly anxious. I realized that my hands were trembling and my face was starting to flush. I looked into the patient eye and asked him to take a sit. Then I paused, doctor asked me to take his vitals. Still my hands were shaking, couldn’t place the BP cuffs right, the tubes started to tangle, sweat running down my forehead and through by side burn; I cautiously started to pump and, went through all the steps and successfully took the patient’s blood pressure, temperature, and pulse, following all the standard procedures and explaining each step along the way. The doctor then asked me to take the history, I was a little nervous that I’d completely freeze up when it was time to take history. I tried, but I was way off track didn’t know exactly what to ask. I knew from T.V shows, like “ER” and “Life in Trauma” the mnemonics they use “SAMPLE” (S=Sing and symptoms; A= Allergy; M= Past and current medication; P= provoke; L= last intake; E= further examination, biochemical, x-ray and so….). Once I finished with my first patient, I told the patient to see the “big doctor”.
The doctor looked thru what I had written, then he put a smile on his face and proceeded with his examination. After he was done with the patient, he turned to me and said, “ history taking is very important skill, and you will learn through out your clinical days”.

I ended up doing O.K on my first patient evaluation and vital performance and didn’t make a complete fool out of myself in front of the patient. But this experience really got me thinking. I’ve taken blood pressures so many times during my first year, and second year, that I can’t understand why I was so nervous this time. It’s such an easy procedure and it shouldn’t have been big deal. I think it might have to do with the fact that I’ve always been lower on the totem pole while being in hospitals and clinical setting.
If the doctor thought my reported blood pressure reading seemed way off they’d usually take it again to make sure, because they have the ultimate responsibility for the patient and not me. The doctor is the one who writes the prescriptions and has to make the important calls.
Now that I’ll be training to be a doctor, I realize that my responsibility to the patient is much higher. I will eventually be making the calls that will affect the course of the patient’s health, instead of just following the orders, and I think that make me a bit nervous.

I hope that I can learn from this first patient encounter and evaluation. But it’s nice to at least have the first obstacle out of the way before I move into the clinical.

[Sanju]

Hi Probin! You've posted after such a long time. Good to see that you are enthusiastic about clinicals. Good luck with your results.

[necrosis]

Its very good that you are experiencing clinical touch even before but don't stick to that mneumonic you will land up in the trouble just keep my word inside your head, forget that.

If you were ask how you would take history and you say those words you will have a threat of your life. Better have some books on history taking and clinical examination with you ask your seniors.

[CSF]

necrosis is right... follow some standard books by the way have you visited this link

http://www.xenomed.com/forums/accm/

there are sample history too


it will be helpful to you

[Sarensa]

hey probin its good that u are keen in learning. That's good. But always remember clinicals is all about basic only difference is that in basic u study in books and in clinicals u see n learn with the patients. If u wish to do good in clinicals ur basic should be strong.
N lastly best of luck for ur results.

[Probin]

Thankx, CSF, necrosis n sarensa,
I do have the Angel's concise clinical book, that is only after the experience
i visited Angel sir, and he recommended the book
it' really good, but, as first time reader without much clinical background i think figure in the book may be helpful,

[RAAZ]

Dear Probin, first thing, a book is a guide to everthing. In clinicals you can't just read a book and learn everything by yourself. Even figures won't help. First you read it to get a basic concept and then you learn the process from your seniors or teachers and then next time if you revise the process in the book, you won't need any figures. Then each time you want to perform the examination you read the book before hand and you will be able to visualize all the procedures that you did or saw in the past. So, in clinicals believe in practical performance and then the book.
As a new comer to clinicals I say that ACCM will really help you a lot if you want a simple and easy guide to clinicals. It has all the contents that you will need to improve your clinical practice and knowledge.
We are always here to guide you if you need any help.

[Probin]

thankx
raaz dai, wat is ACCM, tell me more abt it.????

[CSF]

ACCM click on this link to know about it

[Probin]

Thank you,
i do have the book, its pretty good