Life and limb. My advice to (newly) qualified doctors.

I don’t know if it was my fault for not listening well in medical school but I came away feeling like the perfect history was the holy grail of the medical sojourn. Come to think of it, I graduated with excellent grades so I must have paid SOME attention!

Back then, I watched my registrars being ridiculed because they hadn’t taken an excellent history. The patient is alive and on the road to recovery, but the most crucial question is, “How many windows are in his bedroom?” I still remember the day my consultant humiliated in front of the whole team because when presenting a patient, I had mentioned that she had increased urine output but I hadn’t deigned to estimate the volume. I swore that would never happen to me again. I went and perfected the art of history taking. There was never anything lacking, and I could tell it all from memory. I sailed through the exams. This was before my school embraced OSCE.

Shortly after that, as a qualified doctor, I was in A&E seeing a patient, carefully polishing the history before moving on to examination and then, treatment. In came my senior registrar freaking out. You see, the patient had acute bowel obstruction and needed urgent resuscitation before anything else. She literally was at death’s door and there I was, asking questions.

That was the day my eyes were opened. Occupational history history is irrelevant when the patient is dead. “How many cigarettes do you smoke?” is of no use when the patient doesn’t live to tell you the answer. Patients come to the hospital for treatment. That is all that is important to them. There are times when some seemingly obscure part of the history is immediately relevant, but this is not always the case.

So what is the take away? When assessing patients, always have these questions at the fore of your mind:

1. Is there something here that can kill this patient?

2. Is there something that can lead to loss of limbs? OR

3. Vision?

4. Is there anything here that can significantly alter this patient’s life if not addressed immediately?

Address any urgent problems first with the basic information. Later, you can get the rest of the history if necessary. Think LIFE, LIMB, VISION.

*History: Information obtained from a patient in order to reach a diagnosis.

*Presenting a patient: Telling fellow members of the medical team about a patient and why they’re in hospital.

*OSCE: Objective structured clinical examination. A type of exam designed to test the candidate’s skill in a clinical scenario.

*A&E: Accident and Emergency room