Part 1 - The Art of Clinical Medicine… Getting Rusted
Part 1 - The Art of Clinical Medicine… Getting Rusted - Dr. BS Prajapati
Introduction: Over the last few decades, the science of medicine has progressed very rapidly not only in the field of therapeutics but also in the field of diagnostic technology. But its a sad reality that there is a gradual rusting of clinical medicine & lack of interest for bedside diagnosis among us. Without deriving rational working clinical diagnosis, indiscriminate use of investigations can be expensive & polytherapy can be dangerous for the patient & disastrous for the community. All of us know that detail history, thorough clinical examination, appropriate interpretation of investigations & deriving diagnosis by master analysis of this information is the art of clinical medicine. To learn any art, it requires analytic, meticulous, methodological continuous efforts. The art can not be learnt without devotion & special efforts. It is absolutely true for the clinical medicine too. Paracelsus very rightly said, “Medicine is not only science, it is also an art. It does not consist of compounding pills & plasters; it deals with the very process of life, which must by understood before they may be guided.” Besides knowledge & recent information on the subject, following points are important for learning the art of clinical medicine. Detail Clinical History: To collect the detail information of an illness is the basic requirement of clinical medicine. Patient hearing is one of the good qualities of the clinician. Patient listening to all that the patient wants to tell is not the waste of time, but may offer a clue to the diagnosis. The information provided by the patient is never vague. The patient & the family members may be ill literate, still their observations are more reliable than observations made by any other person. To respect the complaints & observations of the patient is the good quality of the clinician. It is good habit of putting all the points of information on the record. We do not know which point of information is going to be important for reaching the diagnosis. Try to derive the duration of illness. It gives us idea whether it is acute, subacute or chronic illness. What was the first symptom, what was the sequence of other symptoms & how the disease progressed, will define pattern of the disease & likely pathology. Past history & family history will provide supportive information to derive meaningful clinical possibility. One should try to define various possibilities in a given case on the basis of history only. Thorough Clinical Examination: Structural & organized approach is very important for proper clinical examination of the patient. Patient should be examined at an appropriate place only. It can not be examined in the corridor of the hospital or at the residence where facility for the clinical examination is not available. The extra clothes of the patient should be removed before examination. Ideally, the patient should be naked during physical examination. The presence of an appropriate person is essential during examination of the patient. The patient should be examined on the examination table. Several points of clinical examination will be easily missed or misinterpreted while examining the patient who is sitting on the stool besides the clinician. Methodological & well organized examination is always rewarding. Disorganized & haphazard clinical examination is very risky, several important points can be easily missed. Points of examination should be recorded properly, whether it is important or not at the time of examination. Occasionally, the clinical finding which one feels irrelevant at the point of examination, later on, it becomes only clue to reach the diagnosis. Herny Cohen rightly said, “Most errors in clinical medicine are made by making cursory, incomplete examination than due to lack of knowledge & skills. Sir Robert Hutchison said, ‘”There are nor shortcuts to physical diagnosis. It is learnt only by practice not a dull & dreary or monotous practice but practice with all the five senses alert.”
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Dr. Q●●y N●●●●●a
Dr. Q●●y N●●●●●a Paediatrics
Very true sir.. .A detailed clinical history...is more important than any lab test..
Aug 3, 2016Like