I’ve heard it a thousand times. 'The patient wanted testing done.' So the doctor ran a blood test. But few people really want a blood test. What they want is to know that they don’t have something horrible. I’ve seen it a thousand times with young parents. Anxiety competes with their trust in me as we discuss what could be going on with their child. I never ... Continue Reading about The Request for a Blood Test – Why More Testing May Not be Better
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?
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
I used to think they didn’t but they do. Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good ... Continue Reading about Phronesis: Do Patients Have Clinical Judgment?