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	<title>CareerMedicine.com &#187; Clinical Skills</title>
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		<title>How to crack a tough clinical case</title>
		<link>http://www.careermedicine.com/2008/06/how-to-crack-a-tough-clinical-case/</link>
		<comments>http://www.careermedicine.com/2008/06/how-to-crack-a-tough-clinical-case/#comments</comments>
		<pubDate>Tue, 24 Jun 2008 04:44:12 +0000</pubDate>
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				<category><![CDATA[Advice for Better Practice]]></category>
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		<category><![CDATA[Clinical Skills]]></category>

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		<description><![CDATA[What to do when you are stuck with a tough clinical case? What if all labs and imaging that you do is not giving you an answer. You feel like a detective but not like Sherlock Holmes. Here are the ten commandments to solve a difficult clinical case.

1) THOU SHALL LOOK FOR A SINGLE CAUSE [...]]]></description>
			<content:encoded><![CDATA[<p style="text-align: justify;" align="justify">What to do when you are stuck with a tough clinical case? What if all labs and imaging that you do is not giving you an answer. You feel like a detective but not like Sherlock Holmes. Here are the ten commandments to solve a difficult clinical case.</p>
<div style="text-align: justify;">
<blockquote><p><strong>1) <span class="caps">THOU SHALL LOOK FOR</span> A <span class="caps">SINGLE CAUSE FOR SEVERAL SYMPTOMS</span>: </strong>If the patient is exhibiting several symptoms which appear unrelated, then try to link them all together to one cause. Almost always there is a single diagnosis causing all clinical symptoms rather than several diagnoses causing several symptoms.</p>
<p><strong>2) <span class="caps">THOU SHALL GIVE TIME AND REVIEW THOROUGHLY</span>: </strong>Most of the time we encounter simple cases. In our busy lives we encounter mostly simple or straightforward cases. Pneumonia, <span class="caps">UTI </span>etc. But when a clinical mystery comes along you need to stop and think. I sit down with the chart and promise myself not to stop reading it until I find a solution or headway. Usually within 15 to 20 minutes the bulb in the mind will go off. </p>
<p><strong>3) <span class="caps">THOU SHALL HAVE PASSION AND COMPASSION</span>: </strong>Put yourself in patients shoes. Imagine how it feels to be sick without a diagnosis.  Also remember that you first joined medicine to do the glamorous stuff like solving a tough clinical case.</p>
<p><strong>4) <span class="caps">THOU SHALL ASK THY FRIENDS</span>: </strong>You may want to anonymously (without violating <span class="caps">HIPAA</span>) discuss the case with your colleagues. They may come up with some good idea.</p>
<p><strong>5) <span class="caps">THOU SHALL STOP DOING MEDICINE THAT DOES NOT WORK</span>:</strong> If your patient is not getting better on a treatment. Do something different. Do not let some treatment continue when it is not working.</p>
<p><strong>6) <span class="caps">THOU SHALL ADMIT THY LIMITATIONS</span>: </strong>Be honest with your patients. Admit that you don&#8217;t know the diagnosis. But reassure them that you will not rest until you find one. They will respect you for being honest.</p>
<p><strong>7) <span class="caps">THOU SHALL LISTEN LONG ENOUGH</span>: </strong>Do not hesitate to retake the history in a tough clinical case. May be the patient forgot to tell you something. Or may be you did not listen long enough.</p>
<p><strong> <img src='http://www.careermedicine.com/wp-includes/images/smilies/icon_cool.gif' alt='8)' class='wp-smiley' title="How to crack a tough clinical case" /> <span class="caps">THOU SHALL LOOK FOR HORSES</span>: </strong>Remember the saying &#8220;If you hear hoofs, think of horses not Zebras&#8221;. More likely you are looking at a common diagnosis with an uncommon presentation, than an uncommon diagnosis with a common presentation.</p>
<p><strong>9) <span class="caps">THOU SHALL NOT IGNORE</span>: </strong>Just because we are not able to find a diagnosis does not give us a right to ignore it, or call it fibromyalgia. Take all symptoms seriously unless proved otherwise. Ignoring can be a very humbling experience.</p>
<p><strong>10) <span class="caps">THOU SHALL CELEBRATE</span>:</strong> Once you have cracked a challenging clinical diagnosis, you need to boast, feel good and proud about it. Let it all out, after all you deserve it.</p></blockquote>
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		<title>Comforting the patients &#8211; is it a Doctor&#8217;s job ?</title>
		<link>http://www.careermedicine.com/2008/04/comforting-the-patients-is-it-a-doctors-job/</link>
		<comments>http://www.careermedicine.com/2008/04/comforting-the-patients-is-it-a-doctors-job/#comments</comments>
		<pubDate>Wed, 23 Apr 2008 05:09:51 +0000</pubDate>
		<dc:creator>admin</dc:creator>
				<category><![CDATA[Advice for Better Practice]]></category>
		<category><![CDATA[Change Medicine Series]]></category>
		<category><![CDATA[Clinical Skills]]></category>

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		<description><![CDATA[
 
Several times in a  day, physicians find themselves in a situation breaking bad news to the patients. At other times, physicians are informing patients about a preliminary results which needs further testing. And that further testing can lead to a potentially disastrous news. ( Or may be a good news ! ) How should a [...]]]></description>
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<p> </p>
<p>Several times in a  day, physicians find themselves in a situation breaking bad news to the patients. At other times, physicians are informing patients about a preliminary results which needs further testing. And that further testing can lead to a potentially disastrous news. ( Or may be a good news ! ) How should a doctor handle that. One can make an argument that since empathy is a skill not taught in the medical school, may be it is not  a Doctor&#8217;s job to comfort their patient. But lets not jump to a conclusion</p>
<p>Before answering this question, lets put ourselves in the patients shoes.</p>
<blockquote><p>Imagine yourself being taken to a big corporate building (aka hospital). Then you are put into one of the rooms in that big building. You know you cannot leave that building without permission. Then several strangers come into the room and poke needles, take your blood, put cuffs and tubes around you. When you ask them what is going on, they have no clue. They tell you to talk to another stranger (aka doctor) about it. Finally this busy looking stranger comes in to the room. He flaunts his power, tells you the results of a test done on you, casually tells you that further testing may show a diagnosis which can result in your death. Before you could overcome the shock, he leaves the room. You lean  to your family for support but in your heart you know that they cannot help you. The only person who may have the key to your cure was that stranger who had been in the room for 5 seconds. How do you feel at this point !</p>
<p>If you do feel scared, disgusted or hurt, you would rather leave the building. But you can&#8217;t leave without that stranger&#8217;s (aka doctor&#8217;s) permission, who does not give a dime on how you feel. If you do sign out AMA you will be stuck with a big hospital bill which your insurance may refuse to pay. So you wait in that room again to have more strangers come into the room and poke needles into you. And of course a long cold night dealing with the suspense of what that stranger is going to say tomorrow.</p></blockquote>
<p>This is how the patients view their experience. Now lets tackle the argument that if empathy is so important then why is it not taught in the medical school. It is because the whole academic system believes that empathy is common sense. Every physician has empathy but it needs to be triggered. Empathy is common sense until the humanity of a physician is constantly dealing with death, disease and misery. Persistent exposure to vulnerability of a human being makes physicians so numb that the empathetic response does not get triggered when someone is diagnosed with cancer etc.</p>
<p>It is a physician&#8217;s duty not only to diagnose and treat patients but also to make patients comfortable to their new surroundings and experience. Patients call it bedside manners. Those extra minutes spent to comfort the patients may not be reimbursed, but the value they add to your reputation is enormous. It is what defines a good doctor and makes them a <a href="http://www.careermedicine.com/2008/01/tips-for-becoming-a-popular-doctor-and-improve-patient-care-lesson-i/">popular doctor</a>.</p>
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