As the Introductory Clinical Component (ICC) is one of our main forms of patient contact during Phase 1 (which comprises both hospital and general practice sessions), I particularly valued the time I spent seeing patients and practicing clinical examinations. As the ICC sessions draw to a close within the next few months, I thought it would be an opportune time for me to summarize the most important things I learnt from my experience.
The importance of being prepared:
Before attending a session, I would attempt to study the relevant system and its associated clinical conditions from an accessible, easy to read textbook (I highly recommend Macleod’s Clinical Examination). A barometer that I used for assessing my level of preparation involved answering the following questions:
- Can I explain the significance of a particular finding? (e.g. displaced apex beat in a cardiovascular examination)
- Can I state differential diagnoses for common clinical signs? (e.g. jaundice, lymphoedema, central cyanosis)
- Do I know the pathophysiology of the main conditions arising within a system? (e.g. COPD for a respiratory examination)
Carrying the relevant equipment:
I found carrying a piece of paper and a pen helpful as it allowed me to jot down any key points that the consultant was discussing. A working stethoscope is a necessity for most clinical examinations, and other equipment such as a pen torch and stopwatch may be required in certain examinations.
Taking a comprehensive history:
History taking can be very challenging, especially if you don’t have a set framework in your mind about what information you intend to obtain from the patient. I found it helpful to constantly have prompts in my head (for example, drug history or family history) that enabled me to guide the conversation. I also learnt the importance of a meticulous systems review – this involves asking patients about conditions relating to particular systems that they may not have mentioned earlier in the history. For instance, for a patient presenting with a stroke, it may be useful to establish if they have experienced any neurological symptoms in the past.
Learning how to converse with patients:
During the course of my hospital sessions, I found that patients vary greatly – both in terms of their general health and the manner in which they interact with individuals around them. I found it immensely enjoyable to talk to patients as I felt it provided me with insight into the way in which deterioration in health can impact personal lives. It also instilled in me a great appreciation for the way medicine has the capacity to transform lives and really enable patients to achieve their best possible health.