Detective or Doctor?
There is so much advice out there about USMLE prep – where you should go, what you should do, who you should listen to.
What ever you do, when you are practicing, be sure to above all pay attention and give time to your patients. This means standardized patients as well. This would seem obvious, but sometimes students are so focused on diagnosing, they miss the case entirely! This is NOT a game of “Name That Diagnosis! You have three minutes! Go!”
Sometimes, Occam’s Razor be dammed! Heresy you say? Read on….
Find a terrific example here, on another blog I really like, Musings of a Distractable Mind. Dr. Rob Lamberts really understands the vital necessity of excellent communication skills, to the benefit of his patients, and his readers. Things are not always what they seem. Here is just an excerpt from the article:
- Listen to the story. Patients will usually tell you what is wrong with them. Pay attention to the entire history, and don’t make theories until you’ve heard everything.
- Don’t assume you’ve heard everything. Even after you’ve heard everything, you are inevitably missing important information. This may be “chapter 1” of a the patient story, and simply the passage of time will make a confusing story begin to make sense.
- First focus on the things that pose the largest risk. Make sure chest pain is not the heart, fever and cough is not pneumonia, and abdominal pain is not appendicitis. This can be done simply by getting a clearer history, or it may require further testing.
- Then address problems that are common. Common problems presenting in uncommon ways are more common than weird stuff. I look for patterns: episodic abdominal pain suggests gallbladder. Constant chest pain lasting for two days is never ischemic heart pain. Weird chest pain in a 50 year old diabetic smoker is more worrisome than classic pain in a 20 year old female.
There is much more if you read the rest of the article.
So when considering USMLE prep, make sure find a place that will emphasize listening to the patient, gathering the proper data, and THEN reaching the right conclusion.
Yours in excellent USMLE prep,
The C3NY team