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The Patient Will Tell You Their Diagnosis

NewkendraKendra Campbell -- I’ll be finished with my basic science coursework in less than two months. I then have one semester of “Introduction to Clinical Medicine” that I can take in Miami or here in Dominica. After that, I’ll be starting my clinical rotations in US hospitals. After much consideration, I’ve decided to stay here for one semester and do the program at the local hospital. There are many reasons for my decision. Some of them include: not wanting to move all the way to Miami only to stay there for three months, preferring the study environment here versus Miami to prepare for the USMLE Step 1, and most importantly, the clinical experience that I’ll get here versus in Miami.

The hospital here is less equipped with various medical technologies. (I’ll explain why that’s advantageous in a moment.) Also, I’ll see a much broader range of pathologies in Dominica. For example, I will likely see more congenital defects at the hospital here because, unfortunately, many women don’t get proper pre-natal care for various reasons.

In order to be accepted into the program here, I had to write a short essay explaining why I wanted to stay instead of going to Miami. I thought that it would be nice to share it with everyone. There are some people who think I’m crazy for wanting to stay here and live for another three months, especially considering the lack of air conditioning and many other amenities at the local hospital. But I honestly don’t mind putting up with all of the inconveniences if it means that I’ll be a better physician in the end. The following is my essay on why I want to stay:

Sir William Osler once said, “If you listen to your patient, they will tell you their diagnosis.” In my experience thus far, I’ve found this simple statement to be astoundingly true. While I don’t discount the importance and value of modern technologies such as MRIs and CT Scans, I’m a firm believer that a proper history and thorough physical exam will many times lead you to an accurate diagnosis. I have almost completed all of my basic science coursework and I am finally ready to enter the world of clinical medicine. I’ve evaluated my options for my upcoming fifth semester, and I’ve decided that I’d gain the most valuable experience here in Dominica at Princess Margaret Hospital. Although the hospital has less in the way of technologies as compared to the States, I know that many of the physicians there have been practicing in Dominica and other countries for many years. The wisdom and skill that they have gained without relying heavily on technology is profound. I can only hope to acquire a small fraction of that wisdom while learning at Princess Margaret. While I have the rest of my medical career to learn how to use advanced medical technologies, I want to hone my history taking and physical exam skills before I move on. I truly believe that the patient can tell you their diagnosis if you listen carefully enough. That is a skill that I believe I will learn here in Dominica, and that’s why I’d be honored if you accept me into your fifth semester program.

November 2, 2007 in Kendra Campbell | Permalink

Comments

True..unfortunately our training is often lacking in the clinical skills/physical exam component.

Posted by: | Nov 6, 2007 3:01:54 PM

In developing countries, the tenets of a thorough history and physical exam are instilled in medical students. A cool anecdote I was taught was asking a patient if his urine is frothy as a means of assessing a proteinuria.

Posted by: Kene Mezue | Nov 7, 2007 11:38:07 AM

Osler's statement is especially true if the patient has internet access, which unfortunately often confuses the issue!

However, personal experience has shown me that working in a less well resourced environment can hone clinical acumen and decision-making. While the tenets of a thorough history and examination are covered in med school, it is often WAY too easy to fall into the trap of over-investigation (and finding incidentalomas on grope-a-grams) when the facilities there.

Posted by: US Mei | Nov 7, 2007 12:02:20 PM

don´t doubt you´ll be a good physician .clinical wisdom is the result of long time with patients and books. technology is of little aid in confronting the very hard trues of pain and mysery patients and families often suffer.

Posted by: francisco | Nov 7, 2007 1:26:40 PM

with regards to the frothy urine sign and proteinuria, any tall male who stands a considerable distance from the toilet bowl would have frothy urine..

Posted by: clement | Nov 8, 2007 7:02:17 AM

I agree- there's no better substitute to honing the skills for taking a good history and physical exam. Less developed countries usually have their doctors place emphasis on that, though it isn't easy (i'm a personal case-in-point). Besides, technological breakthroughs in medicine never get to such places until 10-20 years after. Bollocks eh?

Posted by: gnazy | Nov 8, 2007 12:47:48 PM

I could never agree more with you .. I truly understand what you mean .. i'm a 5th year egyptian medical student . we don't always have the advanced technology here .. we were taught that we have our ears , eyes , hands and medical intuition which comes with experience and that's far better than the advanced technologies .. Good Luck

Posted by: Sherif El Herraoui | Nov 12, 2007 10:51:56 AM

very nice essay!
u are granted...

Posted by: santosh | Nov 29, 2007 4:41:35 AM

I am an IMG in Canada, doing my MCCEE, MCCQE1 examx equivalent to USMLE EXAMS. My husband is diagnosed with lung cancer in June 2005, He had cough and losing weight since August 2004 , and my husband is regularly visiting his family Dr fo his slightly raised Triglycerides, but Doctor never even took an X RAY,CT scan , but before that he kept my husband on Flovent, and cough syrup for months and his cough never came down, In june 2005 he is diagnosed with Stage 3 Lung cancer, Non small cellcancer, He is not a smoker.The docs cant use the equipment even when they are available.
and it is a developed country, Right

Posted by: Dr Tejashree Burgul | Dec 5, 2007 11:37:33 AM

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