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Medical Entry ( Power of Observation)


Medical student learn clinical skills. . Day by day we are taught to expand our knowledge and sharpen our skills. From the beginning we were taugh to use our hand, our sense to make diagnosis. Day by day we were asked to practice our clinical skills to improve our knowledge when we graduate later.

I make this entry obviously not from my opinion or thinking. This is merely what i remember a few years ago, a consultant in Hospital Queen Elizabeth told me. At that time i was doing my medical posting and my memory regarding that physician name is so cloudy right now. I don't remember him maybe because i've been in a lot of posting since last year.

So what did he say to me? He says something like this:

"Medical student today lack of power in observation. Lots of them only inspect for a few seconds to a minute then jump to palpation, percussion and auscultation. It's wrong. By taking history, you would make 80% of the diagnosis. 20 % is from your physical examination. From that 20%, 10 % is inspection and the rest is for palpation, percussion and auscultation.."

" Do not jump to palpation, give time to observe. By observing the patient, you would know the diagnosis much more compare than touching the patient without watching him/her appropriately. You can observe for 3-4 minutes, it's okay."

"When you are following the round or doing your ward work, what do you seek? You are not seeking to jump to touch every patient or to poke every patient with a needle practicing in drawing blood. When you are in the ward or following the round, what you do is observe. If you are following me for the round, i may not teach you all the time because i was busy but use your senses and observe the patient. By that you would learn more."

"When you look at the patient even if you are not touching them, years later when you see the same characteristic of patient it would assist you in your diagnosis. Don't underestimate the power of observation."

" So i want all the student to practice your power of observation. In does not only limited to visual but also smell and your hearing. If you look, listen and sometimes smell it, you would diagnose the patient even without doing a proper examination."

"Do you see sometimes doctor make diagnosis as early as patient walk into the clinic. That is the power of observation."

I remember this word even if it does not really accurate but it is something like that. I remember it because i like that philosophy. That idea that we need to observe more.

Why i write this thing? haha. It is because my supervisor here in Kuching elective posting is a little quiet type but he is nice. So when we follow his round, much of what we do is observing. Observe observe until we get tired. Then we would jump to auscultation or talk with the patient. Haha.

But seriously the idea of observation is not to be taken as a joke. It is true. I've experience it in my examination. Most of the time i missed a lot of things in inspection? Why? Because in my mind, i want to palpate the lump, the swelling or the pulse quickly.

More details read Hutchingson's Clinical Method. This book is quite not interesting because a lot of words but if you read it, you would find why that other books refer to this book (McCloed and Telley also refer to Hutchingson). This book describe everything in more mind opening way. Love it.

p/s: In this book i've read that when you are examining patient touch sensation, you do not need to ask patient to shut their eyes. This is because it will affect the result as a person's attention will decrease when he shut both eyes. ask the patient to look away. Lots of my lecturer did not accept this method, but i've seen neurologist do this. They did not ask patient to closed their eyes.

enuff...enough said.

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