It sounds like one of those wise advice coming from the older and wiser generation that we all invariably let pass from one ear and out the other, or inside of a crumbled Chinese fortune cookie, but I've found that the way I've been learning in the past few years have not been enough. My mum warned me before starting med school once that "the practice od medicine is not like your exams", she said, "you can't learn for exams as you've been doing so far in your student career, you need to pay attention to minute details. Passing may be fine for exams, but with a real patient, it needs to be 100% every time." I understood what she meant, but I didn't really understand until now.
I am very rusty with my history and examination having been on holiday since November last year, and not properly worked up a patient for the longest time. I realize that there's truth in what the clinical tutors keeping telling us, 90% of diagnosis can be made on history alone, exams and investigations are only there to confirm your differentials. I am finding myself going back to the basics and learning to take a proper history again. Let's hope I will be able to catch up soon.
There's no doubt about the steep learning curve. I walked around ED with a constant dazed look on my face, and countless deer in the headlight moments with consultants. The worst of all, mind blanks when it comes to making referrals to registrars. I told a surg reg that my male patient is having PV bleeding, and after being ridiculed for the obvious stupidity, I could not for the life of me recall the term PR for a good minute, and eventually broke the silent with "he's bleeding from the back side..." Were there any spades around , I'd have dug a big hole and buried my head in it.
Anyway, tomorrow will be a new day, I hope it will all come back to me before they realize how big a fool I am.
