My experiences with general cellular and neural cellular pathology in a case based blended learning ecosystem's CBBLE
Hello,
I'm SAI SHREYA, a medical student from India.
I'll be sharing few of my experiences in the general medicine department clinical postings, but before that I'd like to thank our mentors and HOD sir. They taught us theory and
practice, gave us an inspiration to strive for perfection.
As Hippocrates stated, “Wherever the art of Medicine is loved, there is also a love of Humanity.” I’m sure that all of us are truly connected through this quote. Our choice of medicine wasn’t an accident. I think that medicine is nothing without love of humanity.
It is a delicate and demanding art at the end of which, when well-practiced, is renewed life and freedom from suffering and fear for our patients.
My first ever encounter with a patient was with an old woman who was agitated with pain and all of her family members were worried. She was a 59 year old who was a housewife with complaints of pain in her left pelvic bone since 2 months. It is obviously very difficult to handle the pain for so long but yet she did. Time period usually tells us the chronicity of the illness. I then started with history taking, as it a critical step to know the etiology of a patient's illness.
When I asked her about any previous surgeries, she mentioned that her right hip underwent surgery, in her words "I got a new hip ". I understood that she meant a Total Hip Replacement for her right hip. I took history of how she underwent that surgery and what made her to undergo the surgery.
To understand any etiology of an illness, it is important to know about the patients daily routine as it can rule out many occupational hazards or basically anything that could possibly be the reason of their illness. Her daily routine was quiet simple but there was decreased physical activity.
I continued with her examination, after a very detailed history I waited for a day to check her lab reports, and surprisingly she was negative for RF, which confused me pretty much because I had a guessing that it could be Rheumatoid Arthritis, due to her complaints with pain in her small joints and especially now that her two large joints that is her both hip joints have been involved. My main clinical finding that led me to this provisional diagnosis was morning stiffness, which was relieved in an hour or so depending on the her movements. It had to be Rheumatoid Arthritis.
When the RF test was negative, I was curious to know what other illness could give out the same diagnosis as RA but little did I know that it was not necessary for RF test to be positive in all RA cases. Checking for ESR, CRP helped me identify that there is active inflammation in her body.I learnt a lot when I had to present this case to my mentors and HOD sir. Their questions helped me a lot as they made me curious to know more about it.
Here is a link for my first ever blog:
https://saishreyarollno202.blogspot.com/2022/03/rheumatoid-arthritis-case.html
I then encountered many other cases, but this one case that made me learn Respiratory system examination proper was this one.
A 70 year old male patient with chief complaints of cough since 5 days, shortness of breath since 5 days and chest pain since 5 days.
Like always, I began to take a detailed history of this and when I asked about his shortness of breath, he said he did not have any chest tightness, chest palpitations. orthopnea or paraoxysmal nocturnal dyspnea. So I mainly focused on my respiratory system examination. It was my first time ever to hear a crepitus because before this I would not know the difference between a normal breath sound and an added sound.
This made me happy and I made my friends hear to it as well. Because of this, it made me more enthusiastic to do every step of respiratory system examination properly. A day passes by and then I find out that the patient was an active case of TB. I was distraught and asked every mentor that day if I was gonna be fine. I was very concerned and just tried to have a healthy immune system after. One thing I learnt from this was that I cannot go to every patient without a mask or a glove. I have to be very careful when it comes hospital acquired infections as for many doctors it is an occupational hazard itself.
Fortunately, two days later I find out the patient was not an active case of TB. I was relieved. Meanwhile the next day, I had to present the same case to my mentor so she told me to wait along the bedside of the patient and she said she would watch how I did my examination and help me better in few areas. I went to AMC ward and searched for him but weirdly he was not there so I thought he might have gotten shifted to ICU, went there and find out that the patient passed away due to sepsis. It was the first time ever that the death of a patient made me a little disturbed.
Here's the link of the blog of this patient:
https://saishreyarollno202.blogspot.com/2023/04/a-70-year-old-male-with-cough-sob-and.html
It reminded me of a quote "Death is not opposite of life but it is a part of life" So never stop learning; never stop asking questions; and never forget that medicine is an art as well as a science practiced by doctors and researchers who bring to the bedside – and to the bench – not only technology and training, but also their humanity, caring, and concern.
Shreya first of all, I would like to appreciate you for your hard work in helping some of the patients to get better both physically & psychologically.
ReplyDeleteThe good point is you tried to describe your experiences in a case-based manner - things you learned & problems u faced.
But you only described 2 cases - I can understand u can't present everything - but rather than describing one case in detail, u can tell us about your days in the department by seeing the maximum number of cases - sharing your experiences and learning points in brief.
Like what have you learned from the patient?
How did it help you and your patient?
How much can u review the literature and use it in solving their problem or not?
Finally, your learning in total and patient follow-up?
Individual patient blogs would be more impactful if you describe everything in detail - the daily routine of the patient - the sequence of events - your approach towards addressing the patient's problems - the final turn of events - the course of events in the hospital and your discussion with learning points around that particular patient at the end with proper follow up.
By the end of your history taking you should be able to make a probable diagnosis - the organ system involved - which was provisionally confirmed by your examination and finally some necessary investigations.
A good history is more informative than most of the sophisticated investigations.
Investigations are meant to confirm your diagnosis but not to make a diagnosis.
Ultimately some will recover and some will not - but what really matters is the effort u have put in understanding and solving the patient's problems.
And in patients who improved we need to ask ourselves if everything that we have done is really enough for the patient. Only a good doctor-patient relationship and timely follow-up will answer.