How To Pass A Medicine Long Case Exam

                    I was quite a big fan of Hugh Laurie aka Dr House for a T,V series House MD. This series is based on medical related diseases, diagnosis and management in which Hugh Laurie, with his exceptional sarcasm and arrogance, solve the mysterious cases and set a stir of craze in medical students. He often use a dialogue in this series;

Everybody lies ... !!!

I have experienced this situation myself. How? ... Let me tell you.

                  *Today during Long Case assessment of Medicine" 

Asim: Sir! Why you came to hospital?
Patient: I was having weakness in my left side of the body.
Asim: ... Anything else ?
Patient: ... 8 days back I consulted a Dr for the same reason.
Asim: ... But why you landed in Emergency Department? Is that weakness the sole reason?
Patient: ... Yes ... !!!
*45 Mins later*
Asim: ... Patient presented with left sided generalized weakness !
Examiner: ... Wait ... ! ... What ... :O ,,, !!!
(Turned towards patient)
Examiner: ... Why were you admitted in the hospital ?
Patient: ... Sir ! ... I was having vomiting that was blood stained for 2 days.
*Examiner looked at me furiously*
Asim: ... What the hell ... :/ :/ :/ ... Sir ... !!! ... He told me that he came here for generalized weakness of the left side of the body ... !!!
Examiner: ... Asim ... !!! ... You have to dig every information out of patient. I haven't whispered in his ears ... :D :D :D 

                                       *FAIL IN WARD TEST*

                  And in this way I was managed to get fail in my exam. Thing is I wasn't expecting such a sharp 180 degree turn. But at the end what I learnt was;

1- "Somehow patient exaggerate what they are going through." ... Take their illness as disease NOT A DISASTER.

2- "Elderly patient may present with some complaint that when resolves they never tell you about that" ... Patients often tell their recent problems or perhaps ongoing problems rather the presenting complaint at the point of presentation when you are inquiring about history. ALWAYS remember to emphasize of detailed presentation problems at the time of history taking.

3- "Elderly patients often misunderstand or misinterpret what you are trying to ask" ... KEEP IN MIND they are not super humans. Some may have hearing difficulty or some can get into language problem. ALWAYS consider asking the same question with different angles. NOT EVERY QUESTION BUT THE IMPORTANT ONES.

4- "NEVER ASK A LEADING QUESTION OTHERWISE ... !!!" ... IF you will ask a leading question then he will think about it and say yes he has this symptom right now even if he had that in 1500 BC.

5- "Everybody lies" ... NO ... EVERYONE is not that smart that he lies BUT ... EVERYBODY IS NOT THAT SMART EITHER TO ANSWER YOU SIMPLE QUESTION STRAIGHT TO THE POINT. So, ALWAYS inquire about major questions with different angles to confirm it.

THIS POST WILL HELP YOU TO GET PASS.

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