When I evaluate a new patient, I work to compress data collection and screen time on the front end of the visit so I can free up the remainder of the visit for face-to-face discussion and shared decision making. This intentional visit design is necessary because of the realities of modern clinic schedules. And so the questions I ask and their sequence is important to ... Continue Reading about Clinical Interview Question: What Do You Think is Going On?
I read recently about a patient who spent 4 hours in an ER but was never experienced touch by a human. Not surprising, really. Technology is doing a lot of what we used to do with our eyes, ears and hands. For better or worse. While physicians often associate touch with the physical exam, it can facilitate more powerful things. Here are a few things the hand can ... Continue Reading about Touch | Beyond the Physical Examination
After some deliberation, Johns Hopkins Hospital leadership has determined that their medical interns may wear long white lab coats. Until now the short white lab coat defined medical interns and the age old pecking order of postgraduate medicine in Baltimore. Woulda killed to hear that debate. Although I know how important this stuff can be to young ... Continue Reading about Small Doctors in Big White Lab Coats
Medicine is a dicipline of uncertainty. So clinicians are always looking for indicators of certainty. We’re looking for signs. Medical signs. The psoas sign indicates an inflamed retrocecal appendix. A sentinel node is a classic sign of dissemination of cancer into the chest. The Cheeto finger sign (telltale orange fingers reflecting the recent consumption ... Continue Reading about Medical Signs
Daniel Crook, @EMSafe dropped this in twitter a couple of weeks back: I realise that I have had to learn and do medicine in 7 different ways: What the book says What we actually do What the course says What the College/exam wants What the boss wants What the evidence says What other people will do who don't know the evidence I’ll add this ... Continue Reading about The Zone of Medical Uncertainty
“We’ve gotta keep Mama happy” I hear this from time to time from pediatricians. The idea is that if we don’t give a mother what she’s looking for, she’ll walk. As a resident I had a preceptor who loved to pull me aside to teach me the ‘inside baseball’ of pediatrics. One day after prescribing antibiotics to a child with a runny nose, he remarked with a wink and ... Continue Reading about Keep Mama Happy